The impact of a new hepatopancreatobiliary surgery program on the management of pancreatic cancer at Health Sciences North

• Published in: Canadian Journal of Surgery 2019-08, Vol.62 (4), p.275-280
• Main Authors: Hartford, Luke, Doucet, Véronique, Ramkumar, Julie, Leslie, Ken, Shum, Jeffrey, Asai, Kengo
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - surgery; Aged; Cancer diagnosis; Cancer patients; Cancer surgery; Care and treatment; Digestive system surgery; Digestive System Surgical Procedures; Evaluation; Female; Gastroenterology; Health care access; Health care services accessibility; Health sciences; Health Services Accessibility; Hospitals; Humans; Male; Medical centers; Metadata; Middle Aged; Mortality; Oncology; Ontario; Pancreatic cancer; Pancreatic Neoplasms - surgery; Patient satisfaction; Physicians; Population; Retrospective Studies; Rural areas; Rural health services; Services; Statistical analysis; Studies; Surgeons; Surgery; Surgery Department, Hospital; Surgical outcomes; Time-to-Treatment; Travel
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.016517

Centralization of specialist services to urban centres presents a challenge to patients living in rural communities. The hepatopancreatobiliary surgery (HPB) program at Health Sciences North (HSN) is the tenth and newest HPB centre by Cancer Care Ontario and presents a unique opportunity to evaluate the barriers to delivering HPB cancer care to patients in northern Ontario. We retrospectively reviewed the cases of patients referred to the Northeastern Ontario Cancer Centre and HSN with a pancreatic cancer diagnosis between 2009 and 2015. July 2013 marked the inception of the HPB surgical program. Our primary outcome was time to HPB surgical consultation. Secondary outcomes included distance of travel and time to curative intent operation. Our population consisted of 207 patients (98 pre-HPB v. 109 post-HPB). Median time to consultation with an HPB surgeon was decreased in the post-HPB group (43 v. 11 d, p < 0.001). An increased proportion of patients with pancreatic malignancies in the post-HPB group received HPB surgical consultations (34% v. 74%, p < 0.001), with decreased median distance travelled to surgical consultation (411 v. 79 km, p < 0.001). Time to curative intent operation or medical oncology consultation did not significantly increase. A new HPB program appears to have facilitated the proportion of patients with pancreatic malignancies at HSN receiving an HPB surgical consultation. Patients received complex surgeries, closer to their home regions. It is anticipated that these changes may affect overall outcomes and patient satisfaction and will be the focus of future investigations.