1. The association between quality care and outcomes for a real-world population of Australian patients diagnosed with pancreatic cancer
- Author
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Ashika D. Maharaj, Brett Knowles, Katherine M. White, Marty Smith, Neil D. Merrett, David Goldstein, Jeremy Shapiro, Susan E. Evans, Theresa M. Hayes, Nezor Houli, Daniel Croagh, John Spillane, Rachel Wong, Rachel E. Neale, Jennifer Philip, Mehrdad Nikfarjam, J. Holland, Liane Ioannou, Maddy Quinn, Elizabeth Burmeister, John Zalcberg, Arul Earnest, Trevor Leong, Peter Evans, James G. Kench, and Charles H.C. Pilgrim
- Subjects
medicine.medical_specialty ,education.field_of_study ,Hepatology ,Performance status ,Proportional hazards model ,business.industry ,Hazard ratio ,Population ,Gastroenterology ,Australia ,Cancer ,Disease ,medicine.disease ,Pancreatic Neoplasms ,Chemotherapy, Adjuvant ,Internal medicine ,Pancreatic cancer ,medicine ,Humans ,business ,education ,Radiation oncologist ,Proportional Hazards Models - Abstract
Background Pancreatic cancer (PC) remains a highly fatal disease. There is a gap in the literature on the of quality care on survival in a real-world population. Objectives This study: (1) assessed compliance with a consensus set of quality indicators (QIs); and (2) evaluated the association between compliance with these QIs and survival. Methods Data were collected on a core set of quality indicators by the Upper Gastrointestinal Cancer Registry (UGICR) for patients diagnosed with PC between 1 January 2016 and 31 December 2019. Univariable and multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for the association between survival and patient characteristics, hospital characteristics and QIs, stratified by resectability. A multivariable analysis tested the relationship between significant patient and hospital characteristics, patient cluster effects within hospitals and survival. Results 1061 patients were eligible for this study with 52% male, 71% over the age of 65, 23% potentially resectable and 51% with metastatic disease at diagnosis. 52% received some form of cancer directed treatment. Significant association with improved survival were: (1) in the potentially resectable group having adjuvant chemotherapy administered following surgery or a reason documented (HR, 0.29; 95 CI, 0.19-0.46); (2) in the locally advanced group included having chemotherapy ± chemoradiation, or a reason documented for not undergoing treatment (HR, 0.38; 95 CI, 0.25-0.58) and (3) in the metastatic disease group included having documented ECOG at presentation and/or American society of Anaesthesiologists (ASA) performance status at a diagnostic procedure (HR, 0.65; 95 CI, 0.47-0.89), being seen by a medical oncologist and/or a radiation oncologist in the absence of treatment (HR, 0.48; 95 CI, 0.31-0.77), and having disease management discussed at an MDT meeting (HR, 0.79; 95 CI, 0.64-0.96). Conclusion Capture of a concise data set has enabled quality of care to be assessed and an analysis of factors associated with improved survival identified.
- Published
- 2021