Division of Hepatopancreatobiliary, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Ann Surg Oncol. 2024 Jan;31(1):58-65. doi: 10.1245/s10434-023-14375-6. Epub 2023 Oct 13.
Comparative studies evaluating quality of care in different healthcare systems can guide reform initiatives. This study seeks to characterize best practices by comparing utilization and outcomes for patients with pancreatic cancer (PC) in the USA and Ontario, Canada.
Patients (age ≥ 66 years) with PC were identified from the Ontario Cancer Registry and SEER-Medicare databases from 2006 to 2015. Demographics and treatment (surgery, radiation, chemotherapy, or multimodality (surgery and chemotherapy)) were described. In resected patients, neoadjuvant therapy, readmission, and 30- and 90-day postoperative mortality rates were calculated. Survival was assessed using Kaplan-Meier curves.
This study includes 38,858 and 11,512 patients with PC from the USA and Ontario, respectively. More female patients were identified in the USA (54.0%) versus Ontario (46.9%). In the entire cohort, US patients received more radiation in addition to other therapies (18.8% vs. 13.5% Ontario) and chemotherapy alone (34.3% vs. 19.0% Ontario). While rates of resection were similar (13.4% USA vs.12.5% Ontario), multimodality therapy was more common in the UAS (9.0% vs. 6.4%). Among resected patients, neoadjuvant chemotherapy was uncommon in both groups, although more frequent in the USA (12.0% vs. 3.2% Ontario). The 30- and 90-day postoperative mortality rates were lower in Ontario vs. the USA (30-day: 3.26% vs. 4.91%; 90-day: 7.08% vs. 10.96%), however, overall survival was similar between the USA and Ontario.
We observed substantive differences in treatment and outcomes between PC patients in the USA and Ontario, which may reflect known differences in healthcare systems. Close evaluation of healthcare policies can inform initiatives to improve care quality.
在不同的医疗体系中评估医疗质量的对比研究可以为改革举措提供指导。本研究旨在通过比较美国和加拿大安大略省的胰腺癌（PC）患者的利用情况和结局来确定最佳实践。
从 2006 年至 2015 年，从安大略癌症登记处和 SEER-医疗保险数据库中确定了年龄≥66 岁的 PC 患者。描述了人口统计学和治疗方法（手术、放疗、化疗或多模式治疗（手术和化疗））。在接受手术治疗的患者中，计算了新辅助治疗、再入院和术后 30 天和 90 天死亡率。使用 Kaplan-Meier 曲线评估生存情况。
本研究包括分别来自美国和安大略省的 38858 例和 11512 例 PC 患者。在美国，女性患者（54.0%）多于安大略省（46.9%）。在整个队列中，美国患者接受放疗以及其他治疗的比例更高（18.8% vs. 13.5%，安大略省），以及单独接受化疗的比例更高（34.3% vs. 19.0%，安大略省）。尽管手术切除率相似（美国为 13.4%，安大略省为 12.5%），但美国多模式治疗更为常见（9.0% vs. 6.4%）。在接受手术治疗的患者中，新辅助化疗在两组中均不常见，但在美国更为常见（12.0% vs. 3.2%，安大略省）。与美国相比，安大略省的 30 天和 90 天术后死亡率较低（30 天：3.26% vs. 4.91%；90 天：7.08% vs. 10.96%），但美国和安大略省的总体生存率相似。
我们观察到美国和安大略省的 PC 患者在治疗和结局方面存在实质性差异，这可能反映了医疗体系的已知差异。对医疗保健政策的仔细评估可以为改善护理质量的举措提供信息。
