Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 20;20(1):192.
doi: 10.1186/s12904-021-00870-8.

Regional and age differences in specialised palliative care for patients with pancreatic cancer

Mathilde Adsersen  1 , Inna Markovna Chen  2 , Louise Skau Rasmussen  3 , Julia Sidenius Johansen  2   4   5 , Mette Nissen  4 , Mogens Groenvold  6   7 , Kristoffer Marsaa  8   9
Affiliations

Regional and age differences in specialised palliative care for patients with pancreatic cancer

Mathilde Adsersen et al. BMC Palliat Care. .

Abstract

Background: Despite national recommendations, disparities in specialised palliative care (SPC) admittance have been reported. The aims of this study were to characterize SPC admittance in patients with pancreatic cancer in relation to region of residence and age.

Method: The data sources were two nationwide databases: Danish Pancreatic Cancer Database and Danish Palliative Care Database. The study population included patients (18+ years old) diagnosed with pancreatic cancer from 2011 to 2018. We investigated admittance to SPC, and time from diagnosis to referral to SPC and first contact with SPC to death by region of residence and age.

Results: In the study period (N = 5851) admittance to SPC increased from 44 to 63%. The time from diagnosis to referral to SPC increased in the study period and overall, the median time was 67 days: three times higher in Southern (92 days) than in North Denmark Region. The median number of days from diagnosis to referral to SPC was lower in patients ≥70 years (59 days) vs patients < 70 years (78 days), with regional differences between the age groups. Region of residence and age were associated with admittance to SPC; highest for patients in North Denmark Region vs Capital Region (OR = 2.03 (95%CI 1.67-2.48)) and for younger patients (< 60 years vs 80+ years) (OR = 2.54 (95%CI 2.05-3.15)). The median survival from admittance to SPC was 35 days: lowest in Southern (30 days) and highest in North Denmark Region (41 days). The median number of days from admittance to SPC to death was higher in patients < 70 years (40 days) vs ≥ 70 years (31 days), with a difference between age groups in the regions of 1-14 days.

Conclusions: From 2011 to 2018 more patients with pancreatic cancer than previously were admitted to SPC, with marked differences between regions of residence and age groups. The persistently short period of time the patients are in SPC raises concern that early integrated palliative care is not fully integrated into the Danish healthcare system for patients with pancreatic cancer, with the risk that the referral comes so late that the patients do not receive the full benefit of the SPC.

Keywords: Age; End of life; Geographic residence; Palliative care; Pancreatic cancer; Survival.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A) Time from diagnosis to referral to SPC (N = 4260), B) Time from referral to SPC to admittance to SPC (N = 3497) C) Time from admittance to SPC to death (N = 3497) D) Time from diagnosis to death (N = 5851)
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33. doi: 10.3322/caac.21654. - DOI - PubMed
    1. McWilliams RR, Maisonneuve P, Bamlet WR, Petersen GM, Li D, Risch HA, Yu H, Fontham ET, Luckett B, Bosetti C, et al. Risk factors for early-onset and very-early-onset pancreatic adenocarcinoma: a pancreatic Cancer case-control consortium (PanC4) analysis. Pancreas. 2016;45(2):311–316. doi: 10.1097/MPA.0000000000000392. - DOI - PMC - PubMed
    1. Rasmussen LS, Fristrup CW, Jensen BV, Pfeiffer P, Weber B, Yilmaz MK, Poulsen L, Ladekarl M, Østerlind K, Larsen JS, et al. Initial treatment and survival in 4163 Danish patients with pancreatic cancer: a nationwide unselected real-world register study. Eur J Cancer. 2020;129:50–59. doi: 10.1016/j.ejca.2020.01.015. - DOI - PubMed
    1. Golan T, Sella T, Margalit O, Amit U, Halpern N, Aderka D, Shacham-Shmueli E, Urban D, Lawrence YR. Short- and long-term survival in metastatic pancreatic adenocarcinoma, 1993-2013. J Natl Compr Cancer Netw. 2017;15(8):1022–1027. doi: 10.6004/jnccn.2017.0138. - DOI - PubMed
    1. Burris HA, 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, Cripps MC, Portenoy RK, Storniolo AM, Tarassoff P, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15(6):2403–2413. doi: 10.1200/JCO.1997.15.6.2403. - DOI - PubMed