Not All Hospitals Equal When It Comes to Pancreatic Cancer Care

Academic medical centers that perform more tumor surgeries had better patient outcomes, study found

By Mary Elizabeth Dallas

Monday, May 8, 2017

MONDAY, May 8, 2017 (HealthDay News) -- When it comes to treating pancreatic cancer, where you have your surgery may have some impact on how long you live, according to a new study.

The researchers found that people who travel to an academic medical center to undergo surgery for pancreatic cancer live a few months longer than those who choose to have their operation at a hospital closer to home.

High-volume surgical centers also tended to provide better care for patients with pancreatic or thyroid cancer, but few people opt to travel for their surgery, the study authors said.

"Little was known about whether traveling to receive surgical cancer care results in differences in perioperative outcomes and overall survival," said senior investigator Dr. Raymon Grogan. He is an assistant professor of surgery at the University of Chicago Medicine.

"Yet, there is a well-established relationship between a surgeon's high volume of operations and patients' improved outcomes for pancreatic and thyroid cancer. And most high-volume surgeons in the United States practice in metropolitan settings and academic referral medical centers," Grogan said in a news release from the American College of Surgeons.

For the study, the researchers looked at two types of cancer: papillary thyroid cancer, and pancreatic ductal adenocarcinoma.

The thyroid cancer studied is usually slow growing. Treatment rarely results in complications, and the five-year survival rate is approximately 97 percent, according to Grogan.

Pancreatic ductal adenocarcinoma, on the other hand, is usually an aggressive form of cancer with a much lower survival rate.

The study included information on more than 105,000 people with papillary thyroid cancer and nearly 23,000 people with pancreatic ductal adenocarcinoma from the U.S. National Cancer Database.

Patients who traveled for treatment generally went between 20 and 84 miles away from home. These distances correlated with care at an academic medical center, the study authors said.

The patients with aggressive pancreatic cancer who lived in rural and urban areas who traveled to an academic medical center for their care lived an average of two months longer than those who had surgery at a local hospital, the findings showed.

These patients were more likely to have their lymph nodes removed. They also had better rates of "clear margins" -- which means no microscopic evidence of cancerous tissue is left behind after cancer surgery, according to the report.

There were no travel-related survival differences observed for people with thyroid cancer. The study did find that when these patients traveled, they were more likely to get care that follows national cancer treatment guidelines.

"Our data do not necessarily show that patients who don't travel for cancer care receive suboptimal care," said Grogan. "Rather, patients who travel more often receive the 'gold standard' care -- care that more often conforms with evidence-based recommendations."

But not that many people chose to travel for their cancer care, the study showed. Only 9 percent of those with thyroid cancer and about 25 percent of the patients with pancreatic cancer opted to have their surgery farther from home.

Dr. Michael White, the study's lead author, pointed out that "poorer survival rates for pancreatic cancer may drive the choice to travel to a medical center that performs a higher volume of these operations." White is a general surgery resident physician at the University of Chicago Medicine.

It's unclear exactly why people choose to undergo cancer surgery closer to home. The study authors speculated that being farther from home has disadvantages, too.

The researchers suggested that when making a decision about whether to travel for surgery, cancer patients should ask their surgeon how many similar operations are performed at his or her hospital each year. People should also ask about complication rates for those surgeries.

The study findings were published online recently in the Journal of the American College of Surgeons.

SOURCE: American College of Surgeons, news release, May 1, 2017

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