Fragmented Care for Pancreatic Cancer Patients at a High-Volume Surgical Center

Area of Science:

• Oncology
• Surgical Oncology
• Health Services Research

Background:

• Pancreatic cancer (PC) treatment increasingly involves multimodal therapy across multiple institutions as surgery centralizes at high-volume centers.
• Fragmented care (FC) describes treatment received at more than one institution, posing potential challenges for PC patients.

Purpose of the Study:

• To evaluate the association between fragmented care (FC) and clinical outcomes in patients with pancreatic cancer (PC).
• To determine if receiving care across multiple institutions impacts chemotherapy initiation, surgical timing, or overall survival in PC patients.

Main Methods:

• Retrospective analysis of 329 nonmetastatic PC patients receiving upfront chemotherapy and surgical evaluation at a high-volume center (2018-2022).
• 1:1 nearest neighbor propensity score matching to compare patients with FC versus those treated solely at the high-volume center.
• Outcomes assessed included chemotherapy delay, time to resection/surgical decision, and overall survival.

Main Results:

• Over one-third of patients (n=124) experienced FC, often living further from the center, in rural areas, or disadvantaged regions.
• FC patients showed a higher prevalence of delayed chemotherapy initiation (>8 weeks from diagnosis) compared to non-FC patients (17.6% vs. 5.6%).
• No significant differences were observed in time to surgical decision, time to resection, or overall survival between the FC and non-FC cohorts.

Conclusions:

• Fragmented care (FC) in pancreatic cancer (PC) management did not lead to worse resection rates or long-term survival.
• FC may mitigate burdens for patients, particularly those facing significant travel for systemic therapy.
• Care coordination strategies are essential to manage FC effectively in PC treatment pathways.