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Many Patients With Operable Pancreatic Cancer Are Not Offered Surgical Treatment
Analysis of data from the
largest cancer database in the country has shown that a significant
proportion of patients with operable pancreatic cancer are not being
offered surgical treatment, even though an operation is the only potential
cure for this type of cancer. Researchers from the National Cancer Database
(NCDB) released their comments today on this groundbreaking study that
found that 38.2 percent of patients with early-stage pancreatic cancer were
not offered a surgical procedure as a treatment.
"As surgeons, the message we have been sending for many years is that
surgical treatment for early-stage pancreatic cancer can have a positive
impact on survival and quality of life. This study suggests, however, that
the percentage of patients who should have an operation but don't get it,
is alarmingly high," according to Mark S. Talamonti, MD, FACS, chief of the
division of surgical oncology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, and co-researcher of the study.
Dr. Talamonti believes patients are not being offered an operation
because of nihilism and skepticism on the part of medical professionals,
including some surgeons, who question whether patients with pancreatic
cancer can benefit from any treatment at all.
"For physicians who trained before the 1980s and 1990s when studies
started to show some improvement in survival and quality of life from
treatment for pancreatic cancer, the general idea was that there was no
effective treatment for the disease. While this is a very formidable
disease with considerable medical challenges, the reality is that not
everybody has to die. Many patients do benefit by having the appropriate
operation by sufficiently experienced surgeons in high-volume medical
centers," Dr. Talamonti said.
"The pessimistic attitude toward pancreatic cancer and pancreatic
cancer surgery is based on outdated data," explained Karl Bilimoria, MD, a
research fellow at the American College of Surgeons (ACS) and Department of
Surgery, Feinberg School of Medicine, Northwestern University, focusing on
surgical oncologic outcomes and lead author of the study. "Pancreatic
cancer had terrible outcomes in the 1960s. The mortality and complications
associated with surgical procedures for pancreatic cancer and the lack of
effective systemic therapies made the short-term and long-term outlook for
patients rather dismal. But there have been improvements over the last 30
to 40 years, to the point where postoperative mortality is less than 3
percent in many hospitals, and long-term survival rates are now about 30
percent after surgical resection for Stage I disease," Dr. Bilimoria added.
"We need to get the message out to the gatekeepers -- the primary care
and internal medicine physicians, gastroenterologists, and medical
oncologists who see these patients before they are referred to surgeons --
that it's better to operate than not to operate," Dr. Talamonti said.
Data for the study were obtained from the National Cancer Data Base
(NCDB), which is maintained by the American College of Surgeons Commission
on Cancer (CoC). The NCDB accounts for more than 75 percent of all cancers
treated in the United States each year. The database includes information
on more than 20 million patients with cancer who have been cared for at
1,440 hospitals in this country.
NCDB researchers examined data on 292,565 patients with pancreatic
cancer. From 1995 to 2004, they studied 9,559 patients with Stage I disease
who were potential candidates for an operation. Stage I pancreatic cancer
is confined to the pancreas itself, and it typically occurs in 10 percent
to 15 percent of patients initially diagnosed with pancreatic cancer,
according to Dr. Bilimoria.
Although overall utilization of surgical procedures for pancreatic
cancer increased during the period of the study by 14 percent, only 28.6
percent of patients actually underwent an operation. Of the remaining
patients who did not have an operation, 51.7 percent did not have a
documented or identifiable reason why they did not have the procedure. A
total of 38.2 percent of patients were not offered an operation, and 13.5
percent did not undergo a procedure for unknown reasons.
Although the study could not fully explore why patients with operable
cancer did not have a surgical procedure, it did at least identify some
common underlying factors -- advanced age, race, socioeconomic status, and
insurance status. Patients who were not offered an operation tended to be
about 6 years older than those who had one -- 71.7 years versus 65.1 years
on average. Patients also were less likely to have an operation if they
were African American, had lower annual incomes or less education, and were
covered by Medicare or Medicaid.
A surgical procedure also was not offered to many patients whose tumor
was located in the head or the body of the pancreas. "This finding goes
back to a previous perception that the Whipple procedure [also known as
pancreatoduodenectomy, during which surgeons remove the head of the
pancreas, the first portion of the small intestine (duodenum), part of the
bile duct, and sometimes a portion of the stomach] was worse than the
disease. But over the last 10 to 15 years, there have been unequivocal data
that the operation is associated with improvement in quality of life and
survival when done by experienced surgeons. The thought may still exist
that the operation is a bad thing to subject patients to, even though the
data show that is just not true," said Dr. Talamonti.
The American College of Surgeons is beginning to explore how it may
respond to findings from this study. "ACS is looking at not just the
Whipple procedure but cancer surgery in general to make sure segments of
our population are not underserved and that the information that is
disseminated about surgical treatment for pancreatic cancer is accurate,"
Dr. Talamonti, said. "It is imperative to get the information out that
patients who need and qualify for this surgical approach are offered the
operation."
"Pancreatic cancer surgeons should continue to give lectures about the
efficacy of this type of surgery and treatment for pancreatic cancer to
improve the medical community's opinion of what surgeons can do for
patients with pancreatic cancer in 2007," Dr. Bilimoria, said.
Pancreatic cancer is the fourth leading cause of death due to cancer in
this country. The American Cancer Society estimates that in 2007 more than
37,000 individuals will be diagnosed with pancreatic cancer and more than
33,000 will die from the disease.
A complete report of these research findings entitled "National Failure
to Operate on Early-Stage Pancreatic Cancer" will appear in an upcoming
issue of Annals of Surgery. Other authors of the study include David J.
Bentrem, MD, FACS (Northwestern University, Chicago, IL); Clifford Y. Ko,
MD, FACS (University of California, Los Angeles, and VA Greater Los
Angeles); Andrew K. Stewart, MA (American College of Surgeons Commission on
Cancer); and David P. Winchester, MD, FACS (American College of Surgeons).
The study was supported by the American College of Surgeons Clinical
Scholars in Residence program and a research grant from the Northwestern
University Department of Surgery.
The American College of Surgeons is a scientific and educational
organization of surgeons that was founded in 1913 to raise the standards of
surgical practice and to improve the care of the surgical patient. The
College is dedicated to the ethical and competent practice of surgery. Its
achievements have significantly influenced the course of scientific surgery
in America and have established it as an important advocate for all
surgical patients. The College has more than 71,000 members and is the
largest organization of surgeons in the world. For more information, visit
http://www.facs.org.
American College of Surgeons
http://www.facs.org
Mulþi pacienþi cu cancer pancreatic operabil nu sunt oferite de tratament chirurgical - Many Patients With Operable Pancreatic Cancer Are Not Offered Surgical Treatment - articole medicale engleza - startsanatate