Haider H Samawi1, Yaling Yin1, Howard J Lim1, Winson Y Cheung2. 1. Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada. 2. Section of Medical Oncology, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada. winson.cheung@ahs.ca.
Abstract
INTRODUCTION: High level evidence to guide surveillance following curative intent treatment for pancreatic cancer is lacking and this has likely resulted in wide variations in practice. We aim to describe patterns of surveillance and evaluate their impact on outcomes. METHODS: A total of 147 adult patients who received at least one cycle of adjuvant gemcitabine or 5-fluorouracil-based chemotherapy at any one of five British Columbia Cancer Agency centers between 2001 and 2015 were included. Surveillance strategies were classified into two categories: discharged to primary care physicians (PCPs) or follow-up at cancer centers (CC) that included regular clinical assessments, laboratory testing, and/or diagnostic imaging. RESULTS: Median age at diagnosis was 64 (range 38-85) years and 48% were men. More patients were followed by CC than by PCPs (66 vs. 44%). Among the measured prognostic factors, only patients with advanced tumor stage (T3/4) were more likely to be followed by cancer specialists (78 vs. 62%, P = 0.03), while other patient and disease characteristics were balanced between the two groups. In the entire cohort, 100 (68%) patients had a documented recurrence. Patients followed by CC were more likely to receive palliative chemotherapy at recurrence than those followed by PCPs (58 vs. 34%, respectively, P = 0.03). The median overall survival (OS) was 2.82 (95% CI 2.17-3.32) years in the CC group and 3.35 (95% CI 2.85-5.06) years in the PCP group while the median relapse-free survival (RFS) was 1.4 (95% CI 1.37-1.77) and 2.4 (95% CI 2.07-4.59) years, respectively. On multivariate analysis, there was no significant difference in OS between CC and PCP-based surveillance (HR 1.23; 95% CI 0.74-2.04, P = 0.40); however, RFS favored the PCP group (HR 1.62; 95% CI 1.01-2.56, P = 0.04, for the CC group). CONCLUSION: In this population-based analysis, surveillance tests and imaging performed by CC detected recurrences earlier when compared to follow-up by PCPs, but this did not result in OS differences. Patients with more advanced tumors were more likely to be seen at CC. PCPs may play a larger role in the follow-up care of selected low risk patients with resected pancreatic cancer.
INTRODUCTION: High level evidence to guide surveillance following curative intent treatment for pancreatic cancer is lacking and this has likely resulted in wide variations in practice. We aim to describe patterns of surveillance and evaluate their impact on outcomes. METHODS: A total of 147 adult patients who received at least one cycle of adjuvant gemcitabine or 5-fluorouracil-based chemotherapy at any one of five British Columbia Cancer Agency centers between 2001 and 2015 were included. Surveillance strategies were classified into two categories: discharged to primary care physicians (PCPs) or follow-up at cancer centers (CC) that included regular clinical assessments, laboratory testing, and/or diagnostic imaging. RESULTS: Median age at diagnosis was 64 (range 38-85) years and 48% were men. More patients were followed by CC than by PCPs (66 vs. 44%). Among the measured prognostic factors, only patients with advanced tumor stage (T3/4) were more likely to be followed by cancer specialists (78 vs. 62%, P = 0.03), while other patient and disease characteristics were balanced between the two groups. In the entire cohort, 100 (68%) patients had a documented recurrence. Patients followed by CC were more likely to receive palliative chemotherapy at recurrence than those followed by PCPs (58 vs. 34%, respectively, P = 0.03). The median overall survival (OS) was 2.82 (95% CI 2.17-3.32) years in the CC group and 3.35 (95% CI 2.85-5.06) years in the PCP group while the median relapse-free survival (RFS) was 1.4 (95% CI 1.37-1.77) and 2.4 (95% CI 2.07-4.59) years, respectively. On multivariate analysis, there was no significant difference in OS between CC and PCP-based surveillance (HR 1.23; 95% CI 0.74-2.04, P = 0.40); however, RFS favored the PCP group (HR 1.62; 95% CI 1.01-2.56, P = 0.04, for the CC group). CONCLUSION: In this population-based analysis, surveillance tests and imaging performed by CC detected recurrences earlier when compared to follow-up by PCPs, but this did not result in OS differences. Patients with more advanced tumors were more likely to be seen at CC. PCPs may play a larger role in the follow-up care of selected low risk patients with resected pancreatic cancer.
Entities:
Keywords:
Cancer center; Oncologists; Pancreatic cancer; Primary care physicians; Surveillance
Authors: Helmut Oettle; Stefan Post; Peter Neuhaus; Klaus Gellert; Jan Langrehr; Karsten Ridwelski; Harald Schramm; Joerg Fahlke; Carl Zuelke; Christof Burkart; Klaus Gutberlet; Erika Kettner; Harald Schmalenberg; Karin Weigang-Koehler; Wolf-Otto Bechstein; Marco Niedergethmann; Ingo Schmidt-Wolf; Lars Roll; Bernd Doerken; Hanno Riess Journal: JAMA Date: 2007-01-17 Impact factor: 56.272
Authors: Thierry Conroy; Françoise Desseigne; Marc Ychou; Olivier Bouché; Rosine Guimbaud; Yves Bécouarn; Antoine Adenis; Jean-Luc Raoul; Sophie Gourgou-Bourgade; Christelle de la Fouchardière; Jaafar Bennouna; Jean-Baptiste Bachet; Faiza Khemissa-Akouz; Denis Péré-Vergé; Catherine Delbaldo; Eric Assenat; Bruno Chauffert; Pierre Michel; Christine Montoto-Grillot; Michel Ducreux Journal: N Engl J Med Date: 2011-05-12 Impact factor: 91.245
Authors: Alok A Khorana; Pamela B Mangu; Jordan Berlin; Anitra Engebretson; Theodore S Hong; Anirban Maitra; Supriya G Mohile; Matthew Mumber; Richard Schulick; Marc Shapiro; Susan Urba; Herbert J Zeh; Matthew H G Katz Journal: J Clin Oncol Date: 2016-05-31 Impact factor: 44.544
Authors: J P Neoptolemos; J A Dunn; D D Stocken; J Almond; K Link; H Beger; C Bassi; M Falconi; P Pederzoli; C Dervenis; L Fernandez-Cruz; F Lacaine; A Pap; D Spooner; D J Kerr; H Friess; M W Büchler Journal: Lancet Date: 2001-11-10 Impact factor: 79.321
Authors: John P Neoptolemos; Daniel H Palmer; Paula Ghaneh; Eftychia E Psarelli; Juan W Valle; Christopher M Halloran; Olusola Faluyi; Derek A O'Reilly; David Cunningham; Jonathan Wadsley; Suzanne Darby; Tim Meyer; Roopinder Gillmore; Alan Anthoney; Pehr Lind; Bengt Glimelius; Stephen Falk; Jakob R Izbicki; Gary William Middleton; Sebastian Cummins; Paul J Ross; Harpreet Wasan; Alec McDonald; Tom Crosby; Yuk Ting Ma; Kinnari Patel; David Sherriff; Rubin Soomal; David Borg; Sharmila Sothi; Pascal Hammel; Thilo Hackert; Richard Jackson; Markus W Büchler Journal: Lancet Date: 2017-01-25 Impact factor: 79.321
Authors: David K Chang; Amber L Johns; Neil D Merrett; Anthony J Gill; Emily K Colvin; Christopher J Scarlett; Nam Q Nguyen; Rupert W L Leong; Peter H Cosman; Mark I Kelly; Robert L Sutherland; Susan M Henshall; James G Kench; Andrew V Biankin Journal: J Clin Oncol Date: 2009-04-27 Impact factor: 44.544
Authors: Timothy J Kinsella; Yuji Seo; Joseph Willis; Thomas A Stellato; Christopher T Siegel; Deborah Harpp; James K Willson; Joseph Gibbons; Juan R Sanabria; Jeffrey M Hardacre; James P Schulak Journal: Am J Clin Oncol Date: 2008-10 Impact factor: 2.339
Authors: C J Yeo; J L Cameron; K D Lillemoe; J V Sitzmann; R H Hruban; S N Goodman; W C Dooley; J Coleman; H A Pitt Journal: Ann Surg Date: 1995-06 Impact factor: 12.969
Authors: Selina K Wong; Lovedeep Gondara; Daniel J Renouf; Howard J Lim; Jonathan M Loree; Janine M Davies; Sharlene Gill Journal: J Gastrointest Oncol Date: 2021-04