Introduction: As pancreatic surgery becomes concentrated at high-volume centers, there is greater potential for patients with pancreatic cancer (PC) to receive multimodal therapy across multiple institutions. This study evaluated the association of fragmented care (FC) on clinical outcomes among patients with PC.
Methods: A retrospective analysis was performed of patients diagnosed with nonmetastatic PC receiving upfront chemotherapy who then underwent surgical evaluation at a high-volume center between 2018 and 2022. A 1:1 nearest neighbor propensity score match was used to balance cohorts between patients who received FC and those treated only at the high-volume center. Key outcomes included delay in chemotherapy initiation and time to resection or surgical decision, and overall survival.
Results: Of 329 eligible patients, over one-third of patients received FC (n = 124). Patients receiving FC were more likely to live further away from the center (median 80 versus 32 miles, P < 0.001), lived in rural areas (50.0% versus 21.3%, P < 0.001), and in the most disadvantaged areas according to the national area deprivation index (46.8% versus 29.3%, P = 0.003). After matching, FC patients had a higher prevalence of delayed chemotherapy initiation >8 wks from diagnosis (17.6% versus 5.6%, P = 0.006), though there was no significant difference between cohorts regarding time to surgical decision or resection (both P > 0.05). There was no significant difference in survival between cohorts (hazard ratio: 0.79, 95% confidence interval: 0.54, 1.05, P = 0.10).
Conclusions: FC can help alleviate some of the burdens associated with frequent traveling for systemic therapy and was not associated with lower resection rates or long-term survival in pancreatic cancer.
Keywords: Care delivery; Coordination; Fragmented care; Neoadjuvant therapy; Pancreatic adenocarcinoma.
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