Pancreas Cancer Patient Management

2010 Cancer Plan Stakeholder’s Meeting

October 21, 2010

Goal 12: Elevate the Quality of Cancer Care in Maine

to meet or Exceed national standards

Objective 12.1:

• Conduct one to three State of Maine Cancer Outcomes studies per year to monitor concordance with National Comprehensive Cancer Network clinical practice guidelines

Objective 12.2:

• Support at least three professional development opportunities per year

Goal 13: Increase access to quality cancer care

Objective 13.1:

• Improving online resources and assuring at least one public presentation per year of the Maine Cancer Outcomes studies

Objective 13.2:

• Support the maintenance of ACoS CoC-accredited cancer programs

Goal 13: Increase access to quality cancer

care

Objective 13.3:

• Discuss financial, geographic and resource barriers to guideline-directed cancer care in Maine at one regional professional meeting per year

Objective 13.4:

• Increase clinical trial enrollment in Maine to 2%

Incidence of Invasive Pancreatic Cancer,

Maine 2004-2008

Year Number

2004 204

2005 219

2006 189

2007 181

2008 199

992

*Includes only Behavior Code (3). Excludes

histologies greater than 9590.

Distribution of Invasive Pancreatic Cancer by

Regional Node, Maine 2004-2008 combined

Nodes analysis Number Percent

All nodes examined

negative 63 6.3

1 or more nodes positive 85 9.2

Positive aspir. Lymph node 4 0.4

No nodes examined 761 76.1

Unknown 79 8

992 100

Distribution of Pancreatic Adenocarcinoma by

treatment, Maine 2004-2008

Treatment Number Percent

R only 19 2.6

C only 201 27.2

C &R only 127 17.2

S only 37 5.0

S & C only 14 1.9

S & C & R 60 8.1

Unk R (no S & C) 1 0.1

Unk R (no S & yes C) 1 0.1

Recommended & Unk admin C (no S &

R) 8 1.1

C (no R & Unk S) 1 0.1

Unk S (No S & R) 7 0.9

Unk S & R (no C) 1 0.1

None 262 35.5

Total 739 100.0

S=Surgery, C= Chemotherapy, R=Radiation Therapy, Unk=

Unknown

What about Maine?

• No standard protocol for neoadjuvant therapy

• Retrospective review of neoadjuvant cases may allow for “proof of practice”

• Statewide cooperative protocol will allow for seamless patient management

Proposal

• Accept a protocol for neoadjuvant therapy

• Multi-institutional retrospective review of neoadjuvant cases

• Share patient care components

Regional Care Pathway

• 37 hospitals with different patient care components

• 4 hospitals with panc ca volume

• Shared navigator system to centralize care

• Shared diagnostic and therapeutic protocols (including neoadjuvant protocol)

Patient Care Components

• Medical oncology

• Surgical oncology

• Radiation oncology

• Radiology– Pancreas protocol CT

– MRI

• Interventional GI– EUS

– ERCP

Patient Care Components

• Pain & Palliative care

• Genetics

• Oncology nursing

• Upper GI navigator