title: A pancreatic cancer multidisciplinary clinic: insights and outcomes.
abstract: The purpose of this study was to evaluate the impact of a multidisciplinary clinic (MDC) on the treatment of pancreatic ductal adenocarcinoma. We hypothesized that an MDC would improve trial participation, multimodality therapy, neoadjuvant therapy, time to treatment, and survival.
  
  
  
  Pancreatic ductal adenocarcinoma cancer registry patients from 2008-2012 were analyzed. Outcomes of patients evaluated at the MDC were compared with patients not evaluated at the MDC (non-MDC).
  
  
  
  A total of 1408 patients were identified, 557 (40%) MDC and 851 (60%) non-MDC. MDC were more likely to be an earlier stage than non-MDC (P = 0.0005): I - 4% versus 4%, II - 54% versus 43%, III - 11% versus 9%, and IV - 32% versus 44%. MDC were younger than non-MDC (68 versus 70; P = 0.005); however, younger (<75) and older (≥75) patients were more likely to receive treatment in MDC than non-MDC. MDC were more likely to participate in trials than non-MDC (28% versus 14%; P < 0.0001). MDC were more likely to receive treatment than non-MDC (90% versus 71%; P < 0.0001). MDC were more likely to receive two (38% versus 24%; P < 0.0001) or three (12% versus 9%; P = 0.02) therapies than non-MDC. No difference in time to first treatment in MDC than non-MDC (0.95 versus 0.92 mo; P = 0.69). After adjusting for age, stage, and therapy, there was a trend; however, no statistical difference in disease-free survival (hazard ratio [HR] of non-MDC versus MDC 0.80; 95% confidence interval [95% CI] 0.61-1.05; P = 0.11), time to recurrence (HR of non-MDC versus MDC 0.69; 95% CI 0.45-1.04; P = 0.07), or overall survival (HR of non-MDC versus MDC 0.81; 95% CI, 0.62-1.07; P = 0.13).
  
  
  
  Patients evaluated in an MDC were more likely to receive any treatment, receive multimodality therapy, neoadjuvant therapy, and participate in a clinical trial.
authors.affiliation: Division of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Schiffman
authors.affiliation: Department of Biostatistics, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Shira
authors.initials: S
authors.lastname: Abberbock
authors.affiliation: Cancer Registries, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Sharon
authors.initials: S
authors.lastname: Winters
authors.affiliation: International Resources, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Cindy
authors.initials: C
authors.lastname: Valko
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steve
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: hoggme@upmc.edu.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000458:organization & administration*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010414:Pennsylvania; D011379:Prognosis; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Cancer survival; Clinical trials; Multidisciplinary clinic; Outcomes; Pancreatic cancer