Abstract
Given the significant morbidity burden associated with advanced pancreatic cancer (APC), its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Patients diagnosed with APC from 2008 to 2015 and received Gemcitabine (Gem), Gemcitabine plus nab-Paclitaxel (Gem/Nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers across the province were reviewed. Using postal codes, the Google Maps Distance Matrix determined the distance from each patient’s residence to the closest cancer center. Rural and urban status were defined as patients living ≥ 100 and < 100 km from the closest treatment site, respectively. Univariate and Cox regression analyses were applied to examine whether rurality resulted in variations in management and outcomes. In total, we identified 659 patients: median age 68 years, 54.3% men, and 76.6% metastatic disease. For treatment, 67.7, 9.2, and 23.0% received Gem, Gem/Nab, and FOLFIRINOX, respectively. However, there were no differences in baseline clinical characteristics between rural and urban patients (all p > 0.05). Also, there were no significant variations in treatment patterns. For example, time from diagnosis to oncology appointment and time from appointment to treatment were 31.5 and 29.5 days for rural patients and 28.6 and 40.1 days for urban patients, respectively (all p > 0.05). Use of Gem/Nab (10.1% vs 9.1%) and FOLFIRINOX (21.0% vs 23.5%) were similar regardless of rurality. In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 0.864, 95% CI 0.619–1.206, p = 0.09). Our findings suggest that there is no correlation between rurality and outcomes in APC. The strategic and geographic allocation of cancer care delivery across the province of British Columbia may serve as a model for other jurisdictions that experience disparities in the outcomes of cancers that often require complex multidisciplinary care.
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Acknowledgements
Kind support for the study was provided through the Faculty of Medicine, University of British Columbia, the British Columbia Cancer Agency, and the University of Calgary.
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WC designed the study with input from TC. Once the ethics application was approved under WC, patient charts were received through the British Columbia Cancer Registry and sorted by TC. Subsequent analysis was performed by TC and reviewed and interpreted together with WC. The manuscript was co-written by TC and WC.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was waived because this study consisted of a retrospective review of existing records without any direct patient contact. The research ethics board considered this a minimal risk study.
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Canale, T.D., Cho, H. & Cheung, W.Y. A population-based analysis of urban–rural disparities in advanced pancreatic cancer management and outcomes. Med Oncol 35, 116 (2018). https://doi.org/10.1007/s12032-018-1173-9
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DOI: https://doi.org/10.1007/s12032-018-1173-9