Surgery for pancreatic cancer often not offered to patients

AORN Journal,  Oct, 2007  

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Analysis of data from the National Cancer Database has shown that nearly 40% of patients with operable pancreatic cancer Lie, stage I pancreatic cancer) are not being offered surgical treatment, even though surgery is the only potential cure for this type of cancer, according to a June 14, 2007, news release from the American College of Surgeons. Stage 1 pancreatic cancer is confined to the pancreas itself and typically occurs in 10% to 15% of patients initially diagnosed with pancreatic cancer.

From 1995 to 2004, researchers studied data for 9,559 patients with stage 1 pancreatic cancer who were potential candidates for surgery. Of these, only 28.6% underwent surgery. Of the potential surgical candidates who did not undergo surgery,

* 38.2% were not offered surgery, and

* 51.7% did not have a documented or identifiable reason for why they did not undergo surgery.

Although the study could not fully explore why patients with operable cancer did not undergo a surgical procedure, researchers found that patients were less likely to undergo pancreatic surgery if they

* were African American,

* had lower annual incomes or less education, or

* were covered by Medicare or Medicaid.

In addition, older patients were less likely to be offered surgery; patients who were not offered surgery had an average age of 71.7 years compared with an average age of 65.1 years for those who were offered surgery. A surgical procedure also was not offered to many patients whose tumor was located in the head or the body of the pancreas, for which the surgical treatment is the Whipple procedure lie, a pancreatoduodenectomy). This procedure, which at one time was thought to be worse than the disease, is now associated with improvement in quality of life and survival when performed by experienced surgeons.

Researchers theorize that many physicians who were trained before the 1980s and 1990s, when studies began to show improvement in survival and quality of life for patients with pancreatic cancer who underwent surgery, continue to base their surgical decisions on old data that showed dismal outcomes and high mortality rates for pancreatic cancer surgery patients. Today, the mortality rate is less than 3% and long-term survival rates are approximately 30% for patients with stage 1 pancreatic cancer who undergo surgical resection.

Many patients with operable pancreatic cancer are not offered surgical treatment [news release]. Chicago, IL: American College of Surgeons; June 14, 2007.

COPYRIGHT 2007 Association of Operating Room Nurses, Inc.
COPYRIGHT 2008 Gale, Cengage Learning