REFERRAL OF PATIENTS WITH PAIN FROM PANCREATIC-CANCER FOR NEUROLYTIC CELIAC PLEXUS BLOCK

Objective: To assess whether patients with pancreatic cancer-associate d pain living near a pain control center were more likely to undergo n eurolytic celiac plexus block (NCPB) than those living at a distance a nd to determine the rationale of physicians at our institution for ref erring patients for NCPB, Design: We retrospectively reviewed the freq uency of use of NCPB in patients with pancreatic cancer and conducted an anonymous physician survey of referral patterns for NCPB for such p atients, Material and Methods: A prospective database of medical diagn oses and a clinical database at our institution were used to identify patients with pancreatic cancer within three geographic regions who we re assessed during the inclusive years 1980 through 1989: group I (''l ocal'') = all patients with pancreatic cancer in Olmsted County, Minne sota; group II. (''surrounding'') and group III (''distant'') = patien ts referred for pancreatic cancer evaluation who lived within 100 mile s of our institution (excluding Olmsted County) or more than 100 miles from our institution, respectively, Medical records were retrospectiv ely reviewed to assess the use of NCPB at any time during the course o f pancreatic cancer, For the physician survey component, all medical o ncologists, gastroenterologists, and general surgeons at our instituti on who might be responsible for the care of patients with pancreatic c ancer were sent a questionnaire about their referral patterns for NCPB among patients with pancreatic cancer, Results: Overall, approximatel y 15% of the 292 patients with pancreatic cancer studied underwent NCP B, Distance from our pain control center was not found to be associate d with frequency of use of NCPB, Of the 78 physicians surveyed, 59 (76 %) responded, and 35 of the responders (59%) had encountered at least 1 patient with pancreatic cancer during the preceding 12 months, In th at subset of physicians, perceived barriers for referral for NCPB mere limited appointment availability and need for repeating the procedure . Conclusion: On the basis of this study, referral patterns for NCPB i n patients with pancreatic cancer do not seem to be associated with th e geographic distance of a patient's residence from a pain control cen ter, Improving appointment availability for NCPB might increase the nu mber of patients offered this technique for control of pain.