title: Determinants of survival and attempted resection in patients with non-metastatic pancreatic cancer: An Australian population-based study.
abstract: BACKGROUND
  There are indications that pancreatic cancer survival may differ according to sociodemographic factors, such as residential location. This may be due to differential access to curative resection. Understanding factors associated with the decision to offer a resection might enable strategies to increase the proportion of patients undergoing potentially curative surgery.
  
  
  METHODS
  Data were extracted from medical records and cancer registries for patients diagnosed with pancreatic cancer between July 2009 and June 2011, living in one of two Australian states. Among patients clinically staged with non-metastatic disease we examined factors associated with survival using Cox proportional hazards models. To investigate survival differences we examined determinants of: 1) attempted surgical resection overall; 2) whether patients with locally advanced disease were classified as having resectable disease; and 3) attempted resection among those considered resectable.
  
  
  RESULTS
  Data were collected for 786 eligible patients. Disease was considered locally advanced for 561 (71%) patients, 510 (65%) were classified as having potentially resectable disease and 365 (72%) of these had an attempted resection. Along with age, comorbidities and tumour stage, increasing remoteness of residence was associated with poorer survival. Remoteness of residence and review by a hepatobiliary surgeon were factors influencing the decision to offer surgery.
  
  
  CONCLUSIONS
  This study indicated disparity in survival dependent on patients' residential location and access to a specialist hepatobiliary surgeon. Accurate clinical staging is a critical element in assessing surgical resectability and it is therefore crucial that all patients have access to specialised clinical services.
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia. Electronic address: Elizabeth.Burmeister@qimrberghofer.edu.au.
authors.forename: E A
authors.initials: EA
authors.lastname: Burmeister
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Waterhouse
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Jordan
authors.affiliation: Cancer Council NSW, Sydney, Australia; University of Newcastle, NSW, Australia; University of Sydney, NSW, Australia.
authors.forename: D L
authors.initials: DL
authors.lastname: O'Connell
authors.affiliation: Western Sydney University, NSW, Australia; Bankstown Hospital, NSW, Australia.
authors.forename: N D
authors.initials: ND
authors.lastname: Merrett
authors.affiliation: University of New South Wales, NSW, Australia; Prince of Wales Hospital, NSW, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Goldstein
authors.affiliation: The University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Wyld
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Beesley
authors.affiliation: University of Sydney, NSW, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Gooden
authors.affiliation: Queensland University of Technology, Brisbane, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Janda
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: R E
authors.initials: RE
authors.lastname: Neale
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005843:Geography; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D011153:Population; D012737:Sex Factors; D066231:Surgeons; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Cancer care; Health service utilisation; Pancreatic cancer; Surgery; Survival