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Treatment Patterns and Outcomes in Pancreatic Cancer: A Comparative Analysis of Ontario and the USA

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Comparative studies evaluating quality of care in different healthcare systems can guide reform initiatives. This study seeks to characterize best practices by comparing utilization and outcomes for patients with pancreatic cancer (PC) in the USA and Ontario, Canada.

Methods

Patients (age ≥ 66 years) with PC were identified from the Ontario Cancer Registry and SEER-Medicare databases from 2006 to 2015. Demographics and treatment (surgery, radiation, chemotherapy, or multimodality (surgery and chemotherapy)) were described. In resected patients, neoadjuvant therapy, readmission, and 30- and 90-day postoperative mortality rates were calculated. Survival was assessed using Kaplan–Meier curves.

Results

This study includes 38,858 and 11,512 patients with PC from the USA and Ontario, respectively. More female patients were identified in the USA (54.0%) versus Ontario (46.9%). In the entire cohort, US patients received more radiation in addition to other therapies (18.8% vs. 13.5% Ontario) and chemotherapy alone (34.3% vs. 19.0% Ontario). While rates of resection were similar (13.4% USA vs.12.5% Ontario), multimodality therapy was more common in the UAS (9.0% vs. 6.4%). Among resected patients, neoadjuvant chemotherapy was uncommon in both groups, although more frequent in the USA (12.0% vs. 3.2% Ontario). The 30- and 90-day postoperative mortality rates were lower in Ontario vs. the USA (30-day: 3.26% vs. 4.91%; 90-day: 7.08% vs. 10.96%), however, overall survival was similar between the USA and Ontario.

Conclusions

We observed substantive differences in treatment and outcomes between PC patients in the USA and Ontario, which may reflect known differences in healthcare systems. Close evaluation of healthcare policies can inform initiatives to improve care quality.

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Data Availability

Data used in this study are publicly available to other researchers via ICES and SEER-Medicare. The conducted research was not preregistered with an analysis plan in a registry.

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Acknowledgements

This work was funded in part by the National Cancer Institute Cancer Center Core Grant No. P30-CA008748. Authors had access to the study data that support the publication.

Disclaimer

This study contracted ICES Data and Analytic Services (DAS) and used deidentified data from the ICES Data Repository, which is managed by ICES with support from its funders and partners: Canada’s Strategy for Patient- Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research, and the Government of Ontario. The opinions, results, and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI.

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Authors and Affiliations

  1. Division of Hepatopancreatobiliary, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Lily V. Saadat MD, Kevin C. Soares MD, T. Peter Kingham MD, William R. Jarnagin MD, Michael I. D’Angelica MD & Alice C. Wei MD, MSc

  2. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Lily V. Saadat MD

  3. Department of Psychiatry and Behavioral Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Elizabeth Schofield DrPH

  4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Xing Bai MS, Michael Curry MS & Allison Lipitz-Snyderman PhD

  5. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Refik Saskin MSc & Natalie G. Coburn MD, MPH

  6. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Frances C. Wright MD, MEd & Natalie G. Coburn MD, MPH

  7. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Frances C. Wright MD, MEd & Natalie G. Coburn MD, MPH

  8. Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Jonathan C. Irish MD, MSc

Authors
  1. Lily V. Saadat MD
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  14. Alice C. Wei MD, MSc
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Corresponding author

Correspondence to Alice C. Wei MD, MSc.

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Meeting Presentation: This work was presented at the American College of Surgeons Clinical Congress 2021, Virtual Forum.

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Saadat, L.V., Schofield, E., Bai, X. et al. Treatment Patterns and Outcomes in Pancreatic Cancer: A Comparative Analysis of Ontario and the USA. Ann Surg Oncol 31, 58–65 (2024). https://doi.org/10.1245/s10434-023-14375-6

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