Patients with pancreatic cancer are more likely to receive pancreatectomy if they see a private specialist leading up to their diagnosis, according to a study that has raised concerns about disparities in access to the potentially curative treatment.

QIMR Berghofer and University of Queensland-led researchers used the nationally linked Australian Institute of Health and Welfare dataset to identify 22,739 patients (mean age 73, 51% male) diagnosed with pancreatic cancer.

Only 15% of their cohort underwent the surgery, however the rate increased over the course of the study by 1.36% every six months from 2010 to 2018.

When looking at the sociodemographic, health service, and patient factors that might predict pancreatectomy, researchers found patients who saw a private specialist in the six months prior to diagnosis were 60% more likely to undergo pancreatectomy compared with those who didn’t (PR 1.60; 95% CI=1.50-1.72).

Having more GP visits within 6–18 months of diagnosis was also associated with pancreatectomy, with those who had 5–10 and more than 10 visits 29% and 25% more likely to have the surgery, respectively, compared with fewer than 5 GP visits.

Predictably, age appeared to contribute to decisions around surgery, with “very old” patients aged 80 and older having a substantially lower pancreatectomy prevalence than those aged 60-69 (prevalence ratio (PR) 0.16; 95% CI=0.14-0.19).

But the researchers were surprised to also observe a notable discrepancy between the 70-79 age group and the 60-69 age group with a 22% reduced likelihood.

“There is relatively little evidence about the impact of age on post-resection mortality or survival, independently of comorbidities,” the researchers said.

“In light of the limited data about survival, it is important that patients are given the opportunity to consider resection irrespective of their age, and our findings (albeit not conclusive) suggest that this may not be occurring.”

The following factors were also associated with lower pancreatectomy likelihood:

• Being male (7% less likely than being female)
• High comorbidity index score (30% less likely than a low score)
• Living in rural or remote areas (15% and 41% less likely than metro areas)
• Most socioeconomically disadvantaged (25% less likely than most advantaged)

Across states, patients with pancreatic cancer in Queensland, Tasmania, and Victoria all had lower likelihood of pancreatectomy than those in NSW.

“Our findings suggest that disparities in access to potentially curative treatment for pancreatic cancer persist and underscore the relationship with sociodemographic characteristics, clinical factors and healthcare system factors. Research to understand the reasons for the differences according to socioeconomic status and region of residence is crucial in order to inform interventions that will ensure equity of access,” the researchers wrote in ANZ Journal of Surgery [link here].

Study limitations included a lack of data about the reasons for specialist consultations and the lack of detail on the reasons for not undergoing surgery.