Influence of specialization on the management and outcome of patients with pancreatic cancer

Bachmann, M. O. ORCID: https://orcid.org/0000-0003-1770-3506, Alderson, D., Peters, T. J., Bedford, C., Edwards, D., Wotton, S. and Harvey, I. M. (2003) Influence of specialization on the management and outcome of patients with pancreatic cancer. British Journal of Surgery, 90 (2). pp. 171-177. ISSN 1365-2168

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Abstract

Background: Cancer care is increasingly specialized. Relationships between pancreatic cancer care, mortality and patterns of clinical practice among the full spectrum of patients, including those with irresectable tumours, are not well understood. Methods: A cohort of 782 patients diagnosed prospectively with pancreatic cancer in 29 acute hospitals in England and Wales over 1 year were followed for 2–3 years. The effects of doctors' and hospitals' specialization, indicated by annual patient volumes, on operative mortality rates, survival times, and test and treatment provision were studied. Multiple logistic and Cox regression models were used to control for prognostic factors and treatments, providing adjusted odds and hazard ratios associated with a higher volume of ten patients annually. Results: Patients managed by higher-volume hospitals survived significantly longer (hazard ratio 0·88 (95 per cent confidence interval (c.i.) 0·83 to 0·93); P < 0·001). They were more likely to undergo cytological examination (odds ratio (OR) 1·21 (95 per cent c.i. 1·01 to 1·35)), resection (OR 1·44 (1·17 to 1·79)) and biliary stenting (OR 1·17 (1·02 to 1·34)), and were less likely to have bypass surgery (OR 0·66 (0·55 to 0·78)). Patients of higher-volume doctors were more likely to undergo endoscopic retrograde cholangiopancreatography (OR 1·59 (1·19 to 2·11)), percutaneous transhepatic cholangiography (OR 1·50 (1·12 to 2·00)), laparoscopy (OR 1·81 (1·07 to 3·06)), resection (OR 1·84 (1·29 to 2·61)) and bypass surgery (1·71 (1·25 to 2·33)). Conclusion: Specialization appears to improve survival and to promote more thorough investigation.

Item Type:	Article
Uncontrolled Keywords:	sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care
Depositing User:	EPrints Services
Date Deposited:	25 Nov 2010 11:12
Last Modified:	12 Sep 2023 09:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/14670
DOI:	10.1002/bjs.4028

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