Poster Presentation The Pancreas Summit 2025

Factors associated with pancreatectomy among individuals with pancreatic ductal adenocarcinoma in a retrospective cohort study (#13)

Arrisonia C Doubatty 1 , Sitwat Ali 1 2 , Mary Waterhouse 1 , Karen Canfell 3 , Michael Caruana 4 , Daniel G Croagh 5 , Benedict Devereaux 6 , Paul Grogan 4 , Susan J Jordan 2 , Andrew J Metz 7 8 , Joel Rhee 9 , John A Windsor 10 , John Zalcberg 11 12 , Rachel E Neale 1 2
  1. Population Health Program, QIMR Berghofer, Brisbane, Queensland, Australia
  2. School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
  3. School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  4. The University of Sydney, Sydney, New South Wales, Australia
  5. Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  6. Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  7. Epworth Hospital, Melbourne, Victoria, Australia
  8. Jreissati Pancreatic Centre, Melbourne, Victoria, Australia
  9. Discipline of General Practice, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
  10. Surgical and Translational Research Centre, University of Auckland, Auckland, New Zealand
  11. Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
  12. Cancer Research Program, Monash School of Public Health, Monash University, Melbourne, Victoria, Australia

Background: Pancreatectomy offers a potential cure for pancreatic ductal adenocarcinoma (PDAC), but access remains unequal. The causes of these disparities are complex and unclear. We aimed to explore sociodemographic, health service, and patient factors associated with access to pancreatectomy in Australia.

Methods: This retrospective cohort study used a nationally linked administrative health dataset created by the Australian Institute of Health and Welfare (Panlink). We included individuals diagnosed with PDAC from July 2010 to December 2018 in Australian states, excluding Western Australia. Age, sex, socio-economic indexes for areas (SEIFA) quintile, geographical remoteness, comorbidities, and general practitioner (GP) visits were assessed in relation to pancreatectomy. We performed Joinpoint and log-binomial regression analyses to examine pancreatectomy rates and associated exposures.

Results: We identified 22,749 individuals diagnosed with PDAC who met the eligibility criteria. The mean age was 72 years and 51% were male. Overall, 15% of participants received pancreatectomy, with a six-monthly increase of 1.15% (95% confidence interval [CI] 0.47-1.84) between July 2010 and December 2018. Older age, being male, living in non-metropolitan areas, greater socioeconomic disadvantage, and a higher comorbidity index were associated with a lower likelihood of undergoing pancreatectomy. For example, participants living in small rural towns and remote areas were 19% less likely to undergo pancreatectomy compared to those in metropolitan areas (prevalence ratio [PR] 0.81; 95% CI 0.74-0.89). Similarly, those in the most disadvantaged SEIFA quintile were 26% less likely to receive pancreatectomy than those in the least disadvantaged group (PR 0.74; 95% CI 0.68-0.82). In contrast, participants who visited a GP 5-10 times in the year before PDAC diagnosis had a higher prevalence of pancreatectomy (PR 1.18; 95% CI 1.09-1.28), as did those who with more than 10 visits (PR 1.16; 95% CI 1.06-1.27), compared to those who with fewer than 5 visits.

Conclusions: The prevalence of pancreatectomy increased over time between July 2010 and December 2018. However, our findings revealed disparities in accessing this important treatment for PDAC influenced by sociodemographic, health service, and patient factors. Possible causes include a later stage at diagnosis or lower treatment access. Future studies should investigate the mechanisms underlying these associations.