One third of people with metastatic pancreas cancer in Ontario don’t see a medical oncologist and miss out on treatment that may extend their survival, a study published today in CMAJ found.
Drs. Natalie Coburn and Julie Hallet, surgical oncologists and study co-authors, speak below about what their study means for people facing pancreas cancer, their families and the health-care system in Ontario.
What did your study find?
The population-based study looked the data of 15,970 patients in Ontario between 2004 and 2017, and examined how many people consulted with a medical oncologist and how many people underwent treatment following that consultation. One third of patients during the study period with pancreas cancer that had spread did not meet with a medical oncologist. Sixty percent of people who saw a medical oncologist for a diagnosis of pancreas cancer did not receive treatment. These numbers were higher in geographical areas that did not have a cancer centre close by than in urban areas.
Why did you want to look at pancreas cancer?
According to the Canadian Cancer Society, in 2017, an estimated:
- 5,500 Canadians were diagnosed with pancreatic cancer.
- 4,800 Canadians died from pancreatic cancer.
- 2,800 men were diagnosed with pancreatic cancer and 2,400 died from it.
- 2,700 women were diagnosed with pancreatic cancer and 2,400 died from it.
The majority of patients with pancreas cancer are diagnosed with advanced disease and surgery is not possible. But there are treatment options that can considerably help those patients even if cure is not the goal.
We want to help ensure that people faced with pancreatic cancer have the best options for treatment, symptom management and pain management so that they have the best possible survival and quality of life after diagnosis.
We are doing similar research studies looking at other high-fatality cancers.
What do you think are factors in people not getting to a medical oncologist?
There are system issues, like the ability to access to a cancer centre that’s close by or there are lengthy wait times. Sometimes, oncologists only take a referral if a patient has a biopsy-confirmed cancer, and therefore the patient must wait to get that biopsy and the results before being referred. In the instances of pancreas cancer, that wait might mean by the time a patient sees an oncologist, they are no longer well enough to begin treatment.
There’s also stigma associated with pancreas cancer. It’s known to be a deadly cancer. So, the referrals aren’t being made because the patient or the healthcare provider may think there’s ‘no point.’
Is that troubling to you?
Yes. Current chemotherapy treatments can help alleviate symptoms associated with pancreas cancer. So, these treatments may not only lengthen a life, but they can help improve quality of that life during that remaining time.
What do you think could help?
Firstly, we want to debunk the idea that it’s not worth treating pancreas cancer or that treatment is too toxic. We want more people to access a medical oncologist so that they can have informed discussions about treatment options, symptom management and palliative care.
We also want to raise awareness to policymakers about gaps in the healthcare system — how can we ensure people are accessing the standard of care? How can we make it easier to reach a specialist in a timely manner? How do we make sure it’s the right specialist? Often, as surgeons, we receive referrals for patients facing Stage 4 metastatic pancreas cancer, for which surgery is not a feasible option. We take those referrals just to ensure the patient is referred to a medical oncologist. Is there a better way to ensure a smooth pathway to treatment?
Many cancer centres now have Rapid Referral or Diagnostic clinics for breast or prostate cancers, where a patient can access many specialists at one time and move quickly through to treatment. We think people facing pancreas cancer could benefit from this model.