Wide variation in quality of care for pancreatic cancer patients

People with pancreatic cancer experience a ‘worrying’ variation in the quality of care they receive across the country, a new study reveals.

The research published in the MJA this week used a composite scoring system to analyse the experience of 1571 patients from Queensland and New South Wales who were diagnosed with pancreatic cancer between July 2009 and June 2011.

Quality of care was considered higher if patients saw a specialist pancreatic surgeon first, rather than a general surgeon. They were also more likely to receive better care if they presented to a hospital with a high volume of pancreatic cancer cases each year.

Older patients, patients who lived in rural areas rather than major cities and in the most socio-economically disadvantaged areas received lower composite scores, indicating a lower quality of care.

“Our more worrying finding is that this quality of care varied according to the geographical classification and the area level socioeconomic status of the patient’s place of residence, the study authors from the QIMR Berghofer Medical Research Institute said.

The proportion of people receiving recommended care from specialist teams in this group was particularly low – fewer than one-third of patients had been referred to a multi disciplinary team, only half of potentially resectable patients had been referred to a hepatobiliary surgeon, and referral to a clinical trial was only rarely considered, even though these factors have consistently been shown to improve quality of care, they said.

Unsurprisingly the authors also found that higher quality of care was associated with improved survival – an association most strongly seen in patients clinically staged with non-metastatic pancreatic cancer who have more scope for treatment that can increase survival.

According to the researchers, using telemedicine to deliver multidisciplinary team care and formalising referral relationships between rural and metropolitan hospitals would overcome the imbalance of care faced by a large number of Australians with pancreatic cancer.

“Distance causes particular challenges in Australia but they should not be insurmountable,” the authors argued.

“Systems of care need to be implemented which ensure that equitable treatment is provided for all Australian patients with pancreatic cancer.”

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