Meher Angez, Selamawit Woldesenbet, Odysseas P Chatzipanagiotou, Areesh Mevawalla, Elemosho Abdulaziz, Qaidar Alizai, Rabia Bega, Rida Ejaz, Timothy M Pawlik
Compared with non-designated centers, care at NCI-designated centers was associated with greater use of multimodality therapy and improved survival among patients with stage I-III PDAC, whereas non-NCI CoC centers demonstrated outcomes that were generally closer to non-designated centers than to NCI-designated centers. These findings highlight the importance of access to centers delivering coordinated multimodality PDAC care.
BACKGROUND: Cancer center designation may influence treatment patterns and outcomes for patients with pancreatic ductal adenocarcinoma (PDAC); comparative data across non-designated (ND), Commission on Cancer/American College of Surgeons (CoC/ACS), and National Cancer Institute (NCI)-designated centers remain limited. We evaluated associations between designation, multimodality treatment, perioperative outcomes, and survival in stage I-III PDAC.
PATIENTS AND METHODS: The analytic cohort consisted of patients with stage I-III PDAC in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2005-2019), while patients with stage IV disease were assessed using descriptive comparisons. Multivariable models were utilized to assess associations between center designation and outcomes of interest.
RESULTS: Among 12,971 patients, median age was 76 years (IQR 71-81 years), and 54.6% (n = 7083) were female. Most patients received care at non-NCI CoC (42.0%, n = 5446) or NCI-designated centers (39.8%, n = 5,164). Nurse-to-bed ratios were higher at NCI-designated centers (1.61, IQR 1.25-2.22) and non-NCI CoC centers (1.19, IQR 0.91-1.52) compared with ND centers (0.93, IQR 0.60-1.30) (p < 0.001). Multimodality treatment within 180 days post-surgery was more common at NCI centers (56.2%, n = 1327) versus non-NCI CoC (34.2%, n = 1861) and ND centers (33.4%, n = 1725). In adjusted analyses, care at NCI-designated centers was associated with higher odds of undergoing surgical resection (aOR 2.37, 95% CI 2.12-2.65) and lower 1-year mortality hazard (aHR 0.50, 95% CI 0.46-0.54) compared with ND centers.
CONCLUSIONS: Compared with non-designated centers, care at NCI-designated centers was associated with greater use of multimodality therapy and improved survival among patients with stage I-III PDAC, whereas non-NCI CoC centers demonstrated outcomes that were generally closer to non-designated centers than to NCI-designated centers. These findings highlight the importance of access to centers delivering coordinated multimodality PDAC care.