How Collaboration Between Surgeons and Medical Oncologists Affects Outcomes for Patients with Pancreatic Cancer.

BACKGROUND

The number of patients shared between medical providers can serve as a marker of collaboration to improve clinical outcomes. The authors evaluated the association of surgeon and medical oncologist collaboration with pancreatic cancer (PC) patient survival and direct medical spending for Medicare beneficiaries.

METHODS

The Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was queried for PC patients who underwent resection (2014-2019). Provider pairs were created by linking patient's index surgeon and most frequented medical oncologist. The 95th percentile of patients shared by provider pairs was the exposure: high vs. low collaboration. Kaplan-Meier survival analysis and Cause-specific hazard modeling for PC mortality was performed. Quantile regression assessed direct medical spending at one- and six-months post-diagnosis; p < 0.01 was considered significant.

RESULTS

Among 3,496 patients, 6.64% (n = 232) had high collaboration, of which a majority were white race (88.04%), were frail (92.99%), had early-stage disease (80.12%), and were female (51.97%), while few had rural residence (11.8%). Patients with high compared to low collaboration more often were top 50th percentile for income (87.50% vs. 76.99%, p = 0.0002) and hospital volume (88.36% vs. 54.32%, p < 0.0001) and lived in nonrural areas (94.40% vs. 87.78%, p = 0.0025). The five-year overall survival rate significantly increased with high collaboration (23.7% [16.8%-31.4%] vs. 17.3% [15.6%-19.0%]; p < 0.0001). When stratified by age, stage and hospital volume, hazards for PC death decreased with high collaboration (0.70 [0.58-0.84], p < 0.0001). One- and six-month direct medical spending did not significantly differ based on collaboration among patients regardless of quartile.

CONCLUSION

High patient sharing between surgeons and medical oncologists (a proxy for specialist collaboration) is associated with lower mortality without increased direct medical spending among PC Medicare beneficiaries. Mechanisms through which collaboration influences care delivery, expenditures, and outcomes remain incompletely understood.