Factors associated with quality of care for patients with pancreatic cancer in Australia

Elizabeth A Burmeister, Dianne L O'Connell, Susan J Jordan, David Goldstein, Neil Merrett, David K Wyld, Vanessa L Beesley, Helen M Gooden, Monika Janda and Rachel E Neale
Med J Aust 2016; 205 (10): 459-465. || doi: 10.5694/mja16.00567


Objectives: To develop a composite score for the quality of care for patients with pancreatic cancer in Australia; to determine whether it was affected by patient and health service-related factors; to assess whether the score and survival were correlated.

Design, participants and setting: We reviewed medical records of patients diagnosed with pancreatic cancer during July 2009 – June 2011 and notified to the Queensland and New South Wales cancer registries.

Design and main outcome measures: Participants were allocated proportional quality of care scores based on indicators derived from a Delphi process, ranging from 0 (lowest) to 1 (highest quality care). Associations between patient and health service-related factors and the score were tested by linear regression, and associations between the score and survival with Kaplan–Meier and Cox proportional hazards methods.

Results: Proportional quality of care scores were assigned to 1571 patients. Scores for patients living in rural areas were significantly lower than for those in major cities (adjusted difference, 11%; 95% CI, 8–13%); they were higher for patients in the least socio-economically disadvantaged areas (v most disadvantaged areas: 8% higher; 95% CI, 6–11%), who were younger, had better Eastern Cooperative Oncology Group performance status, or who first presented to a hospital with a high pancreatic case volume. Higher scores were associated with improved survival; after adjusting for patient-related factors, each 10 percentage point increase in the score reduced the risk of dying by 6% (hazard ratio, 0.94; 95% CI, 0.91–0.97).

Conclusion: Geographic category of residence may influence the quality of care received by patients with pancreatic cancer, and survival could be improved if they received optimal care.

Please login with your free MJA account to view this article in full

  • Elizabeth A Burmeister1
  • Dianne L O'Connell2
  • Susan J Jordan1
  • David Goldstein3,4
  • Neil Merrett5
  • David K Wyld6,7
  • Vanessa L Beesley1
  • Helen M Gooden8
  • Monika Janda9
  • Rachel E Neale1

  • 1 QIMR Berghofer Medical Research Institute, Brisbane, QLD
  • 2 Cancer Council NSW, Sydney, NSW
  • 3 Prince of Wales Hospital, Sydney, NSW
  • 4 UNSW Prince of Wales Clinical School, Sydney, NSW
  • 5 University of Western Sydney, Penrith, NSW
  • 6 Royal Brisbane and Women's Hospital, Brisbane, QLD
  • 7 University of Queensland, Brisbane, QLD
  • 8 University of Sydney, Sydney, NSW
  • 9 Queensland University of Technology, Brisbane, QLD


This investigation was funded by a National Health and Medical Research Council (NHMRC) project grant. Rachel Neale, Susan Jordan and Monika Janda are funded by NHMRC fellowships. Elizabeth Burmeister is funded by an NHMRC doctoral scholarship.

Competing interests:

David Goldstein has received institutional research grants from Amgen, Pfizer, Celgene, Cancer Institute NSW, and Cancer Australia. He has had unremunerated consultancies with Pfizer, Roche and Bayer, and has sat on data and safety monitoring boards for Roche and Sun Biopharma.

  • 1. Australian Institute of Health and Welfare. Cancer in Australia: an overview, 2014 (AIHW Cat. No. CAN 88; Cancer Series No. 90). Canberra: AIHW, 2014. (accessed Aug 2016).
  • 2. Australian Institute of Health and Welfare. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010 (AIHW Cat. No. CAN 65; Cancer Series No. 69). Canberra: AIHW, 2012. (accessed Aug 2016).
  • 3. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993; 342: 1317-1322.
  • 4. Burmeister EA, O’Connell DL, Beesley VL, et al. Describing patterns of care in pancreatic cancer: a population-based study. Pancreas 2015; 44: 1259-1265.
  • 5. Sharp L, Carsin AE, Cronin-Fenton DP, et al. Is there under-treatment of pancreatic cancer? Evidence from a population-based study in Ireland. Eur J Cancer 2009; 45: 1450-1459.
  • 6. Bilimoria KY, Bentrem DJ, Lillemoe KD, et al. Assessment of pancreatic cancer care in the United States based on formally developed quality indicators. J Natl Cancer Inst 2009; 101: 848-859.
  • 7. Abraham A, Al-Refaie WB, Parsons HM, et al. Disparities in pancreas cancer care. Ann Surg Oncol 2013; 20: 2078-2087.
  • 8. He W, Zhao H, Chan W, et al. Underuse of surgical resection among elderly patients with early-stage pancreatic cancer. Surgery 2015; 158: 1226-1234.
  • 9. Asare EA, Washington MK, Gress DM, et al. Improving the quality of cancer staging. CA Cancer J Clin 2015; 65: 261-263.
  • 10. Waterhouse M, Burmeister E, O’Connell D, et al. Determinants of outcomes following resection for pancreatic cancer: a population-based study. J Gastrointest Surg 2016; 20:1471-1481.
  • 11. Burmeister EA, Jordan SJ, O’Connell DL, et al. Using a Delphi process to determine optimal care for patients with pancreatic cancer. Asia Pac J Clin Oncol 2016; 12: 105-114.
  • 12. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383.
  • 13. Australian Bureau of Statistics. Socio-Economic Indexes for Areas [website]. Updated Sept 2013. (accessed Aug 2016).
  • 14. Australian Population and Migration Research Centre. ARIA and accessibility. Accessibility/Remoteness Index of Australia — ARIA+ (2011) [website]. (accessed July 2016).
  • 15. Bilimoria KY, Bentrem DJ, Ko CY, et al. Multimodality therapy for pancreatic cancer in the US: utilization, outcomes, and the effect of hospital volume. Cancer 2007; 110: 1227-1234.
  • 16. European Partnership Action Against Cancer consensus group. Policy statement on multidisciplinary cancer care. Eur J Cancer 2014; 50: 475-480.
  • 17. Department of Health and Human Services (Victoria). Optimal care pathway for people with pancreatic cancer. Melbourne: DHHS, 2015. (accessed Aug 2016).
  • 18. Martin HL, Ohara K, Chin W, et al. Cancer services in Western Australia: a comparison of regional outcomes with metropolitan Perth. Aust J Rural Health 2015; 23: 302-308.
  • 19. Coory MD, Ho T, Jordan SJ. Australia is continuing to make progress against cancer, but the regional and remote disadvantage remains. Med J Aust 2013; 199: 605-608. <MJA full text>
  • 20. Australian Institute of Health and Welfare. Mortality inequalities in Australia 2009–2011 (Bulletin 124). Aug 2014. (accessed Aug 2016).
  • 21. Langer B, Stern H. An integrated system-wide strategy for quality improvement in cancer surgery. Br J Surg 2007; 94: 3-5.
  • 22. Coit DG. NCCN guidelines and quality cancer care: where have we come from, and where should we be going? J Natl Compr Canc Netw 2016; 14: 373-377.
  • 23. Cheung R. Racial and social economic factors impact on the cause specific survival of pancreatic cancer: a SEER survey. Asian Pac J Cancer Prev 2013; 14: 159-163.
  • 24. Glimelius B, Hoffman K, Sjoden PO, et al. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol 1996; 7: 593-600.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.