Grant: Travel Awards - Institute Community Support

Background: Although pancreatic cancer diagnosis carries a poor prognosis, early diagnosis and prompt surgery can improve patient survival. Unfortunately, several studies have shown that surgery is under-utilized in eligible patients, and this trend has not improved in the past decade. This study represents phase 2 of a three-phase research program designed to assess surgical interventions for patients with pancreas cancer in Canada (phase 1), in the United States (phase 2), and a comparison of both (phase 3). Objective: This study aims to determine if surgery improves survival and whether certain patient characteristics drive the decision to perform surgery. Methods: A group of patients diagnosed with pancreatic cancer between 2004 and 2014 was created using data from the "Surveillance, Epidemiology, and End Results" (SEER) cancer registry program. Statistical models were used to test whether receiving surgery improved survival and whether the decision to perform surgery was based on patient characteristics such as age, sex, race, geographic location, marital status and insurance status rather than cancer characteristics. Results: From the 88,599 patients diagnosed with pancreatic cancer, surgery was performed in 15%. Those undergoing surgery tend to be younger and married. This group had improved survival. Keeping all other characteristics the same, patients who were male, black, divorced, uninsured and/or living outside the United States North East census region were less likely to undergo surgery and had worse prognosis. Overall, the use of surgery did not improve over the 10-year study period. Conclusion: This study confirms that surgery remains under-utilized in eligible patients in the United States, which reflects the current surgical landscape in Canada. Furthermore, sex, race, marital status, insurance status, and geographic location drove the decision to perform surgery and ultimately how long patients survived following diagnosis.