J. Fallon2, O. Standring1, L. Demyan1, E. Gazzara1, S. Hartman1, S. Pasha1, D. King3, J. Herman4, M. J. Weiss1,5, D. DePeralta1, G. Deutsch1 1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department Of Surgery, Manhasset, NY, USA 2Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA 3Northwell Health Cancer Institute, Department Of Medical Oncology/Hematology, New Hyde Park, NY, USA 4Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department Of Radiation Oncology, Manhasset, NY, USA 5Feinstein Institutes for Medical Research, Institute Of Cancer Research, Northwell Health, Manhasset, NY, USA
Introduction: The relationship between diagnosis setting and the onset of cancer care has not been well established in pancreatic cancer. Our group set out to uncover the disparities present between pancreatic cancer patients diagnosed during an emergency presentation (EP) and the outpatient setting (OP) and the impact enrollment in our outpatient PMDC has on these disparities.
Methods: A retrospective review of our institutional cancer registry and PMDC database was performed. Patients diagnosed with primary pancreatic cancer between 2019-2022 and provided definitive treatment within our healthcare system were included. Chi square tests were run for categorical variables and one-way ANOVA with a Bonferroni correction was utilized for continuous variables. Cox-regression analysis was performed to determine overall survival. Statistical significance was set at p<0.05.
Results: Of 665 patients reviewed, 266 met inclusion criteria. 112 patients were diagnosed during an emergency presentation (EP) and 154 patients were diagnosed in the outpatient setting (OP). At the time of diagnosis there were no significant differences in clinical staging (AJCC 8th edition) between two groups (p=0.474) however, the EP cohort was more likely to present with jaundice (p = 0.002) report weight loss (p = 0.017) and have a biliary stent placed (p < 0.001). 46 patients in the EP cohort were enrolled into PMDC vs 55 OP patients (p = 0.374). Time from presentation to definitive treatment was significantly longer for OP cohort compared to EP cohort (55 days vs 43 days; p = 0.034), which appeared to be driven by a significantly longer time from presentation to biopsy (17 days vs 9 days; p = 0.016). Within the OP cohort, patients enrolled in our PMDC had shorter times from biopsy to definitive treatment (30 days vs 43 days; p=0.05). In EP cohort, there was no significant difference between PMDC patients and non-PMDC in times from biopsy to definitive treatment (41 days vs 34 days; p=0.294) and from initial presentation to definitive treatment (47 days vs 41 days; p= 0.344). A Cox regression analysis controlling for age, sex, ECOG, and stage, showed patients diagnosed during an EP had a mortality rate 1.6x greater than those diagnosed in the OP (p = 0.019).
Conclusion: Our analysis concludes that PMDC enrollment decreased time to biopsy and definitive treatment for OP patients, however, PMDC enrollment did not improve time to biopsy and to definitive treatment in EP cohort. Future efforts should focus on determining ways to adapt and expedite PMDC care to meet the needs of EP patients admitted to the hospital.
