title: Advanced pancreatic adenocarcinoma outcomes with transition from devolved to centralised care in a regional Cancer Centre.
abstract: BACKGROUND
  Previous observations suggest suboptimal 'real world' survival outcomes for advanced pancreatic adenocarcinoma. We hypothesized that centralisation of advanced pancreatic adenocarcinoma management would improve chemotherapy treatment and survival from the disease.
  
  
  METHODS
  The data was prospectively collected on all cases of advanced pancreatic adenocarcinoma reviewed through Clatterbridge Cancer Centre according to two groups; 1 October 2009-31st Dec 2010 (devolved care) or 1 January 2013-31 March 2014 (centralised care). Analysis included treatment received, 30-day chemotherapy mortality rate and overall survival (OS).
  
  
  RESULTS
  More patients received chemotherapy with central care (67.0% (n=115) vs 43.0% (n=121); P=2.2 × 10-4) with no difference in 30-day mortality (20.8% vs 25%; P=0.573) but reduced time to commencement of chemotherapy (18 vs 28 days, P=1.0 × 10-3). More patients received second-line chemotherapy with central care (23.4% vs 1.9%, P=1.4 × 10-4), while OS was significantly increased with central care (median: Five vs three months, HR 0.785, P=0.045). Exploratory analysis suggested that it was those with a poorer performance status, elderly or with metastatic disease who benefited the most from transition to central care.
  
  
  CONCLUSIONS
  A centralised clinic model for advanced pancreatic cancer management resulted in prompt, safe and higher use of chemotherapy compared with devolved care. This was associated with a modest survival benefit. Prospective studies are required to validate the findings reported and the basis for improved survival with centralised care.
authors.affiliation: Department of Medical Oncology, Clatterbridge Cancer Centre, Bebington, Wirral CH63 4JY, UK.|Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool L69 3BX, UK.
authors.forename: Olusola O
authors.initials: OO
authors.lastname: Faluyi
authors.affiliation: Department of Medical Oncology, Clatterbridge Cancer Centre, Bebington, Wirral CH63 4JY, UK.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Connor
authors.affiliation: Department of Medical Oncology, Clatterbridge Cancer Centre, Bebington, Wirral CH63 4JY, UK.
authors.forename: Madhuchanda
authors.initials: M
authors.lastname: Chatterjee
authors.affiliation: Clinical Effectiveness Team, Clinical Governance Department, Clatterbridge Cancer Centre, Bebington CH63 4JY, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: Ikin
authors.affiliation: Clinical Effectiveness Team, Clinical Governance Department, Clatterbridge Cancer Centre, Bebington CH63 4JY, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Wong
authors.affiliation: Department of Medical Oncology, Clatterbridge Cancer Centre, Bebington, Wirral CH63 4JY, UK.|Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool L69 3BX, UK.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Palmer
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000458:organization & administration*; D018450:Disease Progression; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration*; D012041:Regional Medical Programs / Q000458:organization & administration*; D012189:Retrospective Studies; D016019:Survival Analysis; D000069341:Transitional Care / Q000458:organization & administration; D016896:Treatment Outcome