Medical and Surgical Oncologist Collaboration and Long-Term Outcomes Among Patients With Pancreatic Cancer

Multidisciplinary collaboration is essential to deliver optimal care for complex diseases such as pancreatic ductal adenocarcinoma (PDAC). We sought to determine the association between medical and surgical oncologists' collaboration and long-term outcomes among patients with PDAC.

We identified all patients with PDAC who underwent pancreatectomy using the SEER-Medicare database between 2015 and 2019. Patients were excluded if a primary treating medical or surgical oncologist was not identified. Collaboration between medical and surgical oncologists was measured as the number of patients shared between specialists over the study period. Primary outcomes of interest include long-term overall survival (OS) and cancer-specific survival (CSS).

A total of 2902 PDAC patients were seen by 1577 medical oncologists and underwent pancreatectomy from 736 different surgeons, representing 2295 unique surgeon-medical oncologist pairs. The average age of diagnosis was 72 y (interquartile range: 68, 77), and approximately one-half were female (n = 1,447, 49.9%). Two-thirds of patients (n = 1930, 67%) received care from a unique surgeon-medical oncologist pair (i.e., did not share any other patient). Patients treated by the highest quartile of patient load volume of surgeons shared patients more frequently with medical oncologists than those treated by low-volume surgeons (n = 365, 38% versus n = 354, 19%; P < 0.001). Each doubling of shared patients (i.e., 1 to 2, 2 to 4) was associated with improved OS (hazard ratio [HR] = 0.94, 95% confidence interval [CI]: 0.89-0.99, P = 0.012) and CSS (HR = 0.96, 95% CI: 0.91-1.01, P = 0.110) in the unadjusted analysis. However, after adjustment for patient- and physician/hospital-level confounders, there was no association with OS (HR = 1.01, 95% CI: 0.94-1.08, P = 0.811) or CSS (HR = 1.02, 95% CI: 0.95-1.09, P = 0.570).

Collaboration between medical and surgical oncologists is not associated with long-term survival among patients with PDAC after adjustment for patient, physician, and hospital-level confounders. These data suggest that patient and treatment-related variables largely drive long-term outcomes rather than interprofessional collaboration between specialists.