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Patients with metastatic pancreas cancer in Ontario often don't have access to specialist consultations, study finds

May 27, 2019

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One third of people with metastatic pancreas cancer in Ontario don’t see a medical oncologist, a study published today in CMAJ found.

The population-based study looked the data of 15,970 patients in Ontario between 2004 and 2017, and examined how many people consulted with a medical oncologist and how many people underwent treatment following that consultation.

One third of patients during the study period with pancreas cancer that had spread did not meet with a medical oncologist. Sixty percent of people who saw a medical oncologist for a diagnosis of pancreas cancer did not receive treatment. These numbers were higher in geographical areas that did not have a cancer centre close by than in urban areas.

Drs. Julie Hallet and Natalie Coburn, surgical oncologists and study co-authors, said many factors influence a person’s decision to undergo treatment or not. Not all patients may wish to receive treatment. While this study didn’t examine those factors, the results suggest that improving access to specialists, and educating both healthcare providers and patients about treatment options, pain and symptom management options and palliative care support could help improve the quality of life for people facing pancreas cancer.

“Pancreas cancer is important to study because there are a high number of deaths from this cancer,” Dr. Coburn said. “The data suggests that there are many missed opportunities for important discussions between patients and cancer specialists. We have better chemotherapy drugs than in the past, but those standards of care aren’t reaching patients. Spreading the reach of the standards of care, starting with a consultation with a medical oncologist, would have a big impact.”

By contrast, about 80 to 90 per cent of patients with colorectal cancer see a medical oncologist and undergo treatment for the disease.

Dr. Hallet says the study aims to shine light on this issue for pancreas and other high-fatality cancers.

“Firstly, we want to debunk the idea that it’s ‘not worth treating’ pancreas cancer. We want more people to access a medical oncologist so that they can have informed discussions about treatment options, symptom management and palliative care. We could achieve better results by getting more people to an oncologist and better access to best practice treatments right now than with new and often expensive experimental drugs in the future,” Dr. Hallet said. “We also want to raise awareness to policymakers about gaps in the healthcare system — how can we ensure people are accessing the standard of care? How can we make it easier to reach a specialist in a timely manner?”

Read a Q and A with the researchers for more information.