Variations in Medical Oncology Utilization for Pancreatic Cancer Patients in Nova Scotia
Bibliographic record
Abstract
Introduction Population studies have shown that only the minority of pancreatic cancer patients receive cancer directed therapy. Methods Primary aim of this study was to evaluate the referral rate for systemic chemotherapy, as a proxy for the quality of health care delivered to patients with pancreatic cancer in the province of Nova Scotia (Canada). The study population included a cohort of all patients older than 18 years of age who had the diagnosis of PC over a ten year period (April 1, 2001-March 31, 2011). Diagnostic codes of the International Classification of Disease for Oncology, 3rd edition were used to select patients with pancreatic cancer from the Nova Scotia Cancer Registry. Univariate and multivariate analyses were used to assess characteristics associated with the likelihood of receiving cancer directed therapy in the form of adjuvant or palliative chemotherapy. Results A total of 1,161 patients were included with mean age of 72 years. Elixhauser comorbdity score >1 was present in 41% of the cohort with 31% of patients living in rural areas and 40% belonging to low income groups. Surgical therapy was performed in 11.7%. Among patients who underwent resection, 60% were referred to medical oncologists for adjuvant chemotherapy vs. 36% for patients who were not surgical candidates (P<0.0001). Medical oncology consultations were completed only in 46% of patients who underwent surgical therapy vs. 31% of patients who were not surgical candidates (P<0.0001). Multivariate analysis of factors associated with referral to medical oncology services were younger age and low comorbidity status. Conclusions In Nova Scotia, cancer directed therapy in the form of surgery or chemotherapy for PC is offered only to a minority of patients. Rates of cancer directed therapy may reflect appropriate considerations of patients' preferences and functional status, however, other factors, including physicians' attitudes, may play a significant role.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| 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".