By Hannah Hoag

Failing Report Card for Pancreatic Cancer Care

Many pancreatic cancer patients are not getting available treatment

By Hannah Hoag

Although surgical treatment of early stage pancreatic cancer has had its fair share of growing pains, it has emerged as the best—and the only potentially curative—treatment. Yet a study published in the August Annals of Surgery finds that more than half of all patients with operable, early stage pancreatic cancer don’t undergo surgery.

Karl Bilimoria, a surgical research fellow at Northwestern University’s Feinberg School of Medicine in Chicago, and his colleagues used the National Cancer Data Base to analyze the records of more than 9,500 patients with early stage pancreatic cancer treated between 1995 and 2004. None of the patients had cancers that had obviously spread to the lymph nodes or to other parts of the body.

Overall, 71 percent of these patients did not receive surgery as part of their treatment. About 16 percent of the 9,500 patients had a clear reason to avoid surgery—they were too old or too ill—and 4 percent refused it. But 38 percent were not offered surgery, and no reason was documented for the remaining 14 percent.

“Pancreatic cancer has been a challenge to treat,” says David Bentrem, a surgeon at Northwestern University’s Feinberg School of Medicine, and one of the study’s authors. The disease is often diagnosed after it has spread beyond the pancreas—and non-surgical treatments like chemotherapy haven’t been as effective as they have for other cancers. “But we found that even those with treatment options weren’t getting treated,” he says.

“It is certainly eye-opening to find out that there are so many folks who could potentially benefit from surgery who simply aren’t being offered that option,” says Michelle Duff, the director of Patient and Liaison Services and Medical Affairs at the Pancreatic Cancer Action Network, a national advocacy organization.

Physicians and patients may have misconceptions about the safety and effectiveness of the surgery, according to William Jarnagin, a surgeon at Memorial Sloan-Kettering Cancer Center in New York City. “They may not be aware of the improvements that have come along … in the past few years,” he says. Hospitals that do a large number of pancreatic cancer surgeries have very low mortality rates related to the surgery or from complications like infections. The rate at some hospitals is 1 percent or less, a large drop from the 25-percent mortality rates seen in the 1960s.

Blacks, people on Medicare and Medicaid, and older patients were less likely to receive surgery, according to the new study. The researchers found that patients were more likely not to be offered surgery if they were black, possibly because they lacked access to high quality, specialized health care centers. The study also found that patients treated at National Cancer Institute–designated cancer centers, academic centers and high-volume hospitals were more likely to undergo surgery, suggesting patients are more likely to encounter surgeons at these institutions who are well-informed about the best treatment options.

These disparities are often seen in health care, says Duff, but special efforts must be made to provide information to the underserved groups. In addition, she says, “People need to understand what their treatment options are. They have to ask questions.”