title: Physician attitudes and treatment patterns for pancreatic cancer.
abstract: BACKGROUND
  Surgery appears to be an underutilized treatment option for pancreatic cancer. Nihilistic physician attitudes may be partly responsible. The study objectives were to analyze physician attitudes towards this disease and determine treatment patterns and outcomes including rates of surgical referral.
  
  
  METHODS
  A survey was administered to 420 physicians in Manitoba to document general knowledge and attitudes. Population based administrative data was accessed for all patients diagnosed with pancreatic cancer between 2004 and 2006 to examine treatment patterns and outcomes.
  
  
  RESULTS
  181 physicians responded to the survey. Most (73%) believed that surgical resection was worthwhile. Of the 413 Manitobans diagnosed with pancreatic cancer, only 11% underwent an attempt at surgical resection. There were 124 patients with stage I or II disease (i.e. potentially resectable), 85 of these patients received no treatment and 39% were not referred to a surgeon. These patients were older than those referred, but did not have more comorbidities.
  
  
  CONCLUSIONS
  Most physicians were insightfully aware of both the survival benefit and potential risks of surgical resection. However, some did overestimate the surgical mortality and underestimate the associated survival benefit. Although advanced age may justly account for some of the patients not receiving a referral, it is reasonable to assume that nihilistic physician attitudes is contributing to the apparent underutilization of surgery for pancreatic cancer. Efforts should be made to ensure that eligible patients are at least offered surgery as a potential treatment option.
authors.affiliation: Faculty of Medicine, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada. umwoodmj@cc.umanitoba.ca
authors.forename: Jarret
authors.initials: J
authors.lastname: Woodmass
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lipschitz
authors.forename: Andrew
authors.initials: A
authors.lastname: McKay
mesh_terms: D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008350:Manitoba; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome