Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Division of Surgical Oncology, University Hospitals, Cleveland, OH, USA.
Ann Surg Oncol. 2024 Mar;31(3):1906-1915. doi: 10.1245/s10434-023-14609-7. Epub 2023 Nov 21.
To identify the association between multidisciplinary clinic (MDC) management and disparities in treatment for patients with pancreatic cancer.
Socioeconomic status (SES) predicts treatment and survival for pancreatic cancer. Multidisciplinary clinics (MDCs) may improve surgical management for these patients.
This is a retrospective cohort study (2010-2018) of all pancreatic cancer patients within a large, regional hospital system with a high-volume pancreatic cancer MDC. The primary outcome was receipt of treatment (surgery, chemotherapy, radiation, clinical trial participation, and palliative care); the secondary outcomes were overall survival and MDC management. Multiple logistic regressions were used for binary outcomes. Survival was analyzed using Kaplan-Meier survival analysis, Cox proportional hazards, and inverse probability of treatment weighting (IPTW).
Of the 4141 patients studied, 1420 (34.3%) were managed by the MDC. MDC management was more likely for patients who were younger age, married, and privately insured, while less likely for low SES patients (all p < 0.05). MDC patients were more likely to receive all treatments, including neoadjuvant chemotherapy (OR 3.33, 95% CI 2.82-3.93), surgery (OR 1.39, 95% CI 1.15-1.68), palliative care (OR 1.21, 95% CI 1.05-1.38), and clinical trial participation (OR 3.76, 95% CI 2.86-4.93). Low SES patients were less likely to undergo surgery outside of the MDC (OR 0.47, 95% CI 0.31-0.73) but there was no difference within the MDC (OR 1.10, 95% CI 0.68-1.77). Across multiple survival analyses, low SES predicted inferior survival outside of the MDC, but there was no association among MDC patients.
Multidisciplinary team-based care increases rates of treatment and eliminates socioeconomic disparities for pancreatic cancer patients.
确定多学科诊疗（MDC）管理与胰腺癌患者治疗差异之间的关联。
社会经济地位（SES）可预测胰腺癌的治疗效果和生存情况。多学科诊疗（MDC）可能会改善这些患者的手术管理。
这是一项回顾性队列研究（2010-2018 年），纳入了一家大型区域性医院系统内所有胰腺癌患者，该系统内设有一个高容量的胰腺癌 MDC。主要结局是接受治疗（手术、化疗、放疗、临床试验参与和姑息治疗）；次要结局是总生存和 MDC 管理。二元结局采用多项逻辑回归。生存采用 Kaplan-Meier 生存分析、Cox 比例风险和逆概率处理加权（IPTW）进行分析。
在 4141 名研究患者中，有 1420 名（34.3%）由 MDC 管理。MDC 管理更可能用于年龄较小、已婚和私人保险的患者，而不太可能用于 SES 较低的患者（均 P < 0.05）。MDC 患者更有可能接受所有治疗，包括新辅助化疗（OR 3.33，95%CI 2.82-3.93）、手术（OR 1.39，95%CI 1.15-1.68）、姑息治疗（OR 1.21，95%CI 1.05-1.38）和临床试验参与（OR 3.76，95%CI 2.86-4.93）。SES 较低的患者在 MDC 之外接受手术的可能性较低（OR 0.47，95%CI 0.31-0.73），但在 MDC 内并无差异（OR 1.10，95%CI 0.68-1.77）。在多项生存分析中，SES 较低预测了 MDC 之外的生存情况较差，但 MDC 患者之间没有关联。
多学科团队为基础的护理可提高胰腺癌患者的治疗率，并消除社会经济差异。
