Primary care vs. oncology-driven surveillance following adjuvant chemotherapy in resected pancreas cancer.
Bibliographic record
Abstract
421 Background: Major oncology societies outline different recommendations following curative intent treatment for pancreas cancer and this has resulted in wide variations in practice among institutions. We aim to describe patterns of surveillance and evaluate their impact on outcomes. Methods: A total of 147 adult patients who received at least one cycle of adjuvant chemotherapy with gemcitabine or 5-fluorouracil monotherapy at any of the British Columbia Cancer Agency centers between 2004 and 2015 were included in this analysis. Surveillance strategies were divided into two groups: discharged to primary care physicians (PCP) or follow up with oncologists that included regular clinical assessments, laboratory testing and/or diagnostic imaging. Results: Median age at diagnosis was 64 (range 38-85) years and 48% were men. More patients were followed by oncologists than PCP (66% vs. 44%). Among the measured prognostic factors, only patients with advanced tumor stage (T3/4) were more likely to be followed by cancer specialists (78% vs. 62%, P = 0.03), while age, gender, performance status, node status, pathologic grade and surgical margins were balanced between the two groups. In the entire cohort, 100 (68%) patients had a documented recurrence. Patient followed by oncologists were more likely to receive chemotherapy on recurrence than those followed by PCP (58% vs. 34%, respectively, P = 0.03). The median overall survival (OS) was 2.82 (95% CI 2.17-3.32) years in the oncology group and 3.35 (95% CI 2.85-5.06) years in the PCP group while the median relapse free survival (RFS) was 2.4 (95% CI 2.07-4.59) and 1.4 (95%CI 1.37-1.77) years, respectively. On multivariate analysis, there was no significant difference in OS between oncology and PCP-driven surveillance (HR 1.23; 95% CI 0.74-2.04, P = 0.4); however, RFS favored the PCP group (HR 1.62; 95% CI 1.01-2.56, P = 0.04, for oncology). Conclusions: In this population-based analysis, surveillance tests and imaging performed by oncologists detected recurrences earlier when compared to follow up by PCPs, but this did not result in OS differences. PCPs may have a larger role in the follow up care of selected patients with resected pancreas cancer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".