Purpose
To assess associations between six diagnostic, staging, and coordination of care indicators in pancreatic cancer, and: (1) surgery being abandoned intraoperatively; or (2) a positive macroscopic margin (R2 resection) or a positive microscopic pathological margin (R1 resection).

Methods
Data was provided by the Upper Gastrointestinal Cancer Registry operating across two Australian states. Associations were tested using multivariable logistic regression.

Results
704 patients underwent an attempted surgical resection (54 % male; median age 69 years). Of the completed resections (n = 585) with a known margin status (n = 513), 54 % (n = 278) were reported as having a negative pathological (R0) margin, 41 % (n = 211) had an R1 margin, and 5 % (n = 24) had an R2 margin. Patients who underwent surgery or neoadjuvant therapy within 60 days from referral had double the odds of a complete resection (OR=2.12, 95 % CI, 1.19 – 3.76). Imaging undertaken beyond 30 days prior to surgery had a 40 % reduction in the odds of a completed resection (OR=0.58, 95 % CI, 0.37 – 0.92). Patients with their ECOG and/or ASA documented at presentation had 90 % increased odds of a R0 margin resection (OR=1.90, 95 % CI, 1.32 – 2.73).

Conclusions
Timely progression to primary treatment had the most significant association with achieving complete resection status. ... Read more

Background: While there is increasing evidence on the benefits of PROMs in cancer care, the extent of routine collection and use of PROMs in clinical cancer practice across Australia and New Zealand (ANZ) is unknown. This study examined the prevalence and characteristics of PROMs use in routine clinical cancer care in ANZ. Methods: An online survey was designed and disseminated via professional societies and organisations using a snowball sampling approach to clinical and health administration professionals managing cancer care in ANZ. A poster advertising the study was also circulated on professional social media networks via LinkedIn and Twitter inviting health professionals from ANZ to participate if they were using or intending to use PROMs in clinical cancer practice. Responders opted into the survey via the survey link. Results: From 132 survey views, 91(response rate, 69%) respondents from 56 clinical practices across ANZ agreed to participate in the survey, and of these 55 (n = 55/91, 60%) respondents reported collecting PROMs within their clinical practice. The majority of the respondents were from the State of New South Wales in Australia (n = 21/55, 38%), hospital (n = 35/55, 64%), and a public setting (n = 46/55, 83%). PROMs were collected in all cancer types (n = 21/36, 58%), in all stages of the disease (n = 31/36, 86%), in an adult population (n = 33/36, 92%), applied in English (n = 33/36, 92%), and used to facilitate communication with other reasons (27/36, 75%). A geospatial map analysis provided insights into the variation in PROMs uptake between the two countries and in certain jurisdictions within Australia. This study also highlights the limited resources for PROMs implementation, and a lack of systematic priority driven approach. Conclusion: PROM use across Australia and New Zealand seems variable and occurring predominantly in larger metropolitan centres with limited standardisation of approach and implementation. A greater focus on equitable adoption of PROMs in diverse cancer care settings is urgently needed. ... Read more