How home address affects cancer's deadly outcome

Published in today’s Medical Journal of Australia, the study shows some patients are almost three times more likely than others to have pancreatic cancer surgery. 

Pancreatic cancer is the deadliest of cancers – less than one in ten people survive five years after their diagnosis.

The MJA report reveals that the proportion of patients who survived five years after their diagnosis was double in regions that had pancreatic surgical rates above 15 per cent (7.2 per cent) compared to regions that had surgical rates below ten per cent (3.4 per cent).

This means patients who attend hospitals that do relatively few pancreatectomies have twice the risk of dying compared to patients that have surgery in a higher volume hospital.

Patients from metropolitan Sydney, and those near big teaching hospitals like Westmead and Royal North Shore Hospital, do better than patients from non-metropolitan areas and smaller hospitals, the report finds.

The finding confirms advice from health authorities that patients who can benefit from a pancreatectomy should be referred to a big metropolitan hospital that performs the procedure regularly.

Still, relatively few people undergo pancreatectomy: between 2010 and 2013, only 14 per cent of NSW patients diagnosed with pancreatic cancer had the procedure, with rates ranging from 8 per cent to 21 per cent across the state – a finding on par with figures internationally.

Why so?

“Many patients aren’t suitable candidates for surgery because their disease is too advanced at the time of diagnosis,” says University of Sydney Associate Professor Arthur Richardson, who is a surgeon and co-author of the study.

“A pancreatectomy is a complex procedure and careful selection of patients who will benefit is crucial. Multi-disciplinary management which includes surgeons, oncologists and radiologists is essential in order to achieve the best results.

“Patients with this deadly disease are best treated in large hospitals with extensive experience in treating pancreatic cancer.”

Chief Executive Office of the Cancer Institute and senior author of the report, Professor David Currow said:

“Survival rates for pancreatic cancer are low for a number of reasons. Due to the late development of symptoms, the disease is usually already at an advanced stage when a person is diagnosed. In itself, this limits the number of people who could benefit from surgery.

“By identifying this variation, we have the opportunity to improve survival for many people diagnosed with pancreatic cancer. We can do this by reducing variation and making sure that people receive the right treatment, at the right time, in the right place,” he says.

“We know survival for people with disease confined to the pancreas can be improved through surgery. Making sure GPs know where and when to refer patients with pancreatic cancer is an important next step,” says Professor Currow.