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Access to radical resections of pancreatic cancer is region-dependent despite the public healthcare system in Finland
  1. Reea Ahola1,
  2. Heini Hölsä2,
  3. Samuli Kiskola2,
  4. Pirkka Ojala2,
  5. Aino Pirttilä2,
  6. Juhani Sand1,
  7. Johanna Laukkarinen1,2
  1. 1 Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
  2. 2 Medicine, University of Tampere, Tampere, Finland
  1. Correspondence to Professor Johanna Laukkarinen, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere 33521, Finland; johanna.laukkarinen{at}


Background Surgical resection is the best treatment option to improve the prognosis of pancreatic cancer (PC). Our aim was to analyse whether PC treatment strategies show regional variation in Finland, a country with a nationwide public healthcare system.

Methods All patients diagnosed with PC in 2003 and 2008 were identified from the Finnish Cancer Registry. The data regarding tumour, treatment, demographics and timespans to treatment were recorded from the patient archives. Patients were included in the healthcare district where the diagnosis was made. The healthcare districts were classified according to experience in pancreatic surgery into three groups (high level of experience region (HLER), n=2; medium level of experience region (MLER), n=6, and low level of experience region (LLER), n=13).

Results Patients included numbered 1546 (median age 72 years (range 34–97), 45% men). Demographics and the ratio of stage IV disease (53%) were similar between the regional groups. Despite this, the proportion of radical surgery was greater in HLERs than in the MLERs and LLERs (18% vs 8%–11%; p<0.01). Logistic regression analysis including age, American Society of Anesthesiologists classification, stage and level of experience showed that more radical resections were performed in the HLERs. Preoperative bile drainage showed no regional differences (p=0.137). Palliative chemotherapy only was used more frequently in MLER and LLER than in HLERs (24% vs 33%–30%; p<0.01).

Conclusion Access to PC curative treatment was more likely for patients in healthcare districts including a hospital with high level of experience in pancreatic surgery. This highlights the importance of centralized treatment guidance.

  • pancreatic cancer
  • public health
  • cancer

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  • Contributors RA: planning, acquisition of data, analysis,interpretation of data, writing, refining and revision of the manuscript. HH, AP, SK and PO: acquisition of data, analysis,reporting and revision of the manuscript. JS and JL: planning, conducting, interpretation of data, writing and revising of manuscript.

  • Funding This work was supported by the State Research Funding (VTR), Finland, and the Sigrid Jusélius Foundation, Finland, which have no involvement in the study design, data collection, data analysis, manuscript preparation or publication decisions.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical committee of Pirkanmaa district.

  • Provenance and peer review Not commissioned; externally peer reviewed.