A new UPMC study of patients with pancreatic cancer has shown that the multidisciplinary clinic (MDC) team approach to treatment can give lower-income patients significantly better survival outcomes than lower-income patients diagnosed and treated without the MDC team approach.
Equally important, the data revealed that the MDC approach neutralizes disparities in the treatment and survival rates of pancreatic cancer patients based on socioeconomic status.
Mining Rich Data Resources
The study is unique not only because of what it revealed but also because of the data it examined. The data came from UPMC Hillman Cancer Center’s own patients who had received robotic-assisted pancreaticoduodenectomies, also known as Whipple procedures, for pancreatic cancer at UPMC over a 10-year period.
Few other medical centers have amassed such high volumes of Whipple outcomes data because of the specialized nature of the surgery. UPMC Hillman surgeons are among the world’s most experienced in performing the robotic-assisted Whipple procedure and have performed more than 750 of these surgeries.
Led by Amer H. Zureikat, MD, FACS, chief of surgical oncology at UPMC Hillman Cancer Center, the institutional study aimed to identify:
- If socioeconomic status played a role in treatment used to manage pancreatic cancer;
- Whether those disease management decisions affected the survival outcomes for patients; and
- If a multidisciplinary approach had any mitigating effects on socioeconomic disparities in treatment outcomes.
Breaking Down the Data
A total of 567 deidentified patients were categorized into groups based on socioeconomic status (SES), as determined by zip-code-based income information, education levels, and occupation to compare results of the highest-SES group with the lowest-SES group. The study excluded the middle-SES group.
Researchers compared disease characteristics, types of treatments received, surgical outcomes, hospital lengths of stay, recurrence rates, and overall survival rates between patients managed inside the pancreatic cancer MDC with those managed outside the MDC. Of the 162 patients in the low-SES group and 119 patients in the high-SES group, 54 percent were managed through UPMC Hillman’s pancreatic cancer MDC with 46 percent managed outside the MDC.
What the Data Revealed
For patients managed outside the MDC, low-SES patients were less likely to receive neoadjuvant (preoperative) chemotherapy to shrink the tumor prior to surgery. In addition, their surgeries on average took longer to perform, were more invasive, and led to less-enhanced recovery participation and more major complications. These disparities were not seen in the low-SES patients who were managed within the MDC.
Further, low-SES patients managed outside the MDC had inferior overall survival rates—living a median of only 17 months after surgery compared with 32 months for high-SES patients not managed in the MDC. However, for those low-SES patients managed within the MDC, survival rates were nearly the same as for high-SES patients—living a median of 24 months after surgery compared with 25 months for high-SES patients. These findings persisted across multiple variables, including age, marital status, and body mass index (BMI).
The study concluded that the pancreatic cancer MDC standardizes treatment decisions, eliminates disparities in surgical outcomes, and improves survival rates for low-SES patients.
What the UPMC Study Means for Low-SES Patients
“For lower-income patients who have pancreatic cancer, this study shows that getting treatment through an MDC can even the playing field by helping them get the latest treatments and less-invasive surgeries, ” says Dr. Zureikat, the principal investigator on the study.
Previous studies by other researchers have shown disparities in cancer care for low-SES patients at so-called “Safety Net Hospitals” across the country, which are large centers that deliver health care to uninsured, Medicaid, and other at-risk patient populations. UPMC Presbyterian and UPMC Shadyside are both part of Pennsylvania’s network of Safety Net Hospitals. However, the new UPMC study shows that the use of the MDC approach can neutralize such disparities for these patients, who are most vulnerable to inferior outcomes.
“We want to re-educate both patients and physicians to think differently about pancreatic cancer,” Dr. Zureikat says. “Pancreatic cancer diagnosis does not have to be an instant death sentence. We want people to know that there are still options that can extend survival—especially for lower-income patients who often are not offered these options.”
Benefits of the MDC Approach
The Pancreatic Cancer MDC at UPMC Hillman includes specialists from pancreatic surgical oncology, medical oncology, radiation oncology, palliative care, nutrition, genetic counseling, and clinical trials personnel, and gives patients immediate access to gastroenterology for specialized tests and procedures.
Once the MDC is contacted, a dedicated care coordinator then works with the patient to take their medical history and schedule necessary tests and appointments within a week of the diagnosis. The MDC offers a “one-stop-shop” experience that enables the patient to see a variety of specialists all on the same day. The MDC team of specialists then confers to create a treatment plan that incorporates standard-of-care therapies—but also includes access to the latest clinical trials and experimental treatments for late-stage disease.
Another benefit of the MDC approach is that patients receiving these life-extending treatment plans at the central UPMC Hillman location can get their follow-up care with their own oncologists at any of the UPMC Hillman satellite cancer centers in their local communities.
“The data show decisively that patients who have complex surgeries such as open or robotic Whipple surgery for pancreatic cancer have much better outcomes in high-volume medical centers,” Dr. Zurekiat adds. “These patients can benefit from the MDC by having their neoadjuvant therapies and surgeries coordinated at our centralized location, then can get the comfort and convenience of continuing their follow-up therapies with their own oncologist closer to home and their support network.”
Why Pancreatic Cancer is So Aggressive
Pancreatic cancer is difficult to diagnose because it often has vague or no symptoms until it is advanced and no reliable early-stage screening tests currently exist. That means pancreatic cancer often is not detected until the later stages when the tumor can no longer be surgically removed or has metastasized or spread to other parts of the body.
According to the American Society of Clinical Oncology (ASCO), if detected early when the tumor can be removed surgically, the 5-year survival rate is 39%; however, only about 1 in 10 people with pancreatic cancer is diagnosed at this early stage. If the cancer has spread to tissues or organs near the pancreas, the 5-year survival rate is 13%. Unfortunately, for roughly half of those diagnosed with pancreatic cancer, the cancer has already spread to distant parts of the body. That 5-year survival rate is only 3%.
While those survival rates are challenging, Dr. Zureikat maintains that the MDC approach still offers hope to patients with pancreatic cancer, especially low-SES patients who fare poorly outside the auspices of an MDC.
“The MDC is a prognostic indicator of improved survival for the most vulnerable patients,” he adds. “The study confirms that low-SES patients should be seen in an MDC and that they can almost double their life expectancy after a pancreatic cancer diagnosis by receiving care through an MCD than outside an MDC.”