NATIONAL PATTERNS OF CARE FOR PANCREATIC-CANCER - RESULTS OF A SURVEYBY THE COMMISSION ON CANCER

Background The Commission on Cancer of the American College of Surgeon s conducted a large, national survey to assess methods of diagnosis, A merican Joint Commission on Cancer staging, treatment, and outcome of patients with adenocarcinoma of the pancreas. Study Design The survey questionnaire contained 160 questions and covered two study periods, 1 983 to 1985 and 1990, for time-trend analysis. Nine hundred seventy-ei ght institutions throughout the United States voluntarily participated , contributing 8917 case reports for 1983 to 1985 and 8025 reports for 1990, resulting in a total of 16,942 patient reports. Most, but not a ll, of the participating hospitals maintain approval status with the C ommission on Cancer of the American College of Surgeons. Results The r atio of male-to-female cases was 1:1. Patient characteristics includin g age, ethnicity, neighborhood income, type of insurance coverage, and hospital characteristics-including annual caseload and type of facili ty (e.g., teaching, community)-appeared to influence surgical multimod ality treatment patterns. The most common presenting symptom was abdom inal pain. The reported history of smoking for these patients with pan creatic cancer was higher than U.S. population averages. The frequency of using abdominal computed tomography scans, endoscopic retrograde c holangiopancreatography, carcinoembryonic antigen, and CA 19-9 during patient evaluation all increased. Time trends toward lower operative m ortality and more extirpative surgery were reported, as was a slightly higher survival for those patients who were resected surgically. Conc lusions Pancreatic cancer continues to be a disease of older patients. There were slight improvements in operative mortality. For a highly s elective category of patients, cancer-directed surgery offers a chance for cure with excellent operative mortality and acceptable complicati on rates, especially when performed in institutions that have a 20 or greater case per year experience.