Claims-based reconstruction of the pancreatic cancer care pathway links centralization of care to survival
- 1Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague
Abstract
BackgroundThe organization of pancreatic cancer care may be associated with survival. Using health administrative claims data, we reconstructed the pathway from diagnosis to first-line therapy and examined associations of multidisciplinary team review and treatment at specialized centers with overall survival.
MethodsLongitudinal historical cohort study using anonymized health administrative claims data from six Czech health insurance funds, covering approximately 17% of patients diagnosed with pancreatic cancer nationally between 2018 and 2020. Adults with an incident ICD-10 C25 record confirmed by imaging and histopathology were followed from the index date (the date of the first qualifying imaging or histopathological examination) until death, censoring, or 31 December 2021. Overall survival was analyzed using Kaplan-Meier methods and Cox regression adjusted for age and first-line therapy type.
ResultsOf 1,255 patients, 920 (73.3%) received first-line therapy and 266 (21.2%) died untreated. Among treated patients, 436 (47.4%) underwent multidisciplinary team review, 335 (36.4%) underwent surgery, and 667 (72.5%) were treated at a complex oncological center. Surgery was associated with longer overall survival than chemotherapy (age-adjusted hazard ratio [HR] 0.32, P < 0.001). Treatment at a complex oncological center was associated with longer overall survival (adjusted HR 0.77, 95% confidence interval [CI] 0.64-0.92, P = 0.004; crude median 532 versus 394 days). Multidisciplinary team review was not significantly associated with overall survival (adjusted HR 0.86, 95% CI 0.73-1.01, P = 0.073).
ConclusionsTreatment at a complex oncological center was associated with longer survival, while fewer than half of patients had a recorded multidisciplinary team review. How care is organized, not only which therapy is delivered, is associated with outcome. The observational design and absence of key clinical covariates limit causal interpretation.
Related
- Coordinated upregulation of Hippo, NF-κB and interferon pathway genes in pancreatic ductal adenocarcinoma: a retrospective tissue qRT-PCR profiling study with external tumour-versus-non-tumour validation, molecular subtype and survival analyses.
- Multiple R1 margins are associated with shorter overall survival: national register-based study on pancreatic cancer
- Precision Targeting of Heparan Sulfate Proteoglycans Broadly Dysregulates Survival Signaling and Metabolic Adaptation in Pancreatic Cancer
- Skeletal Muscle Index, Tumor and Systemic Immunity, and Survival in Advanced Pancreatic Ductal Adenocarcinoma
- Clonogenic survival and relative biological effectiveness of pancreatic ductal adenocarcinoma under pristine and spread-out Bragg peak irradiation with protons and carbon ions.
BibTeX
@misc{laubr2026claimsbased,
title = {{Claims-based reconstruction of the pancreatic cancer care pathway links centralization of care to survival}},
author = {D. Laubr and A. Tichopad and M. Rybar and Z. Bielcikova and M. Lovecek and M. Rozanek and G. Donin},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.17.26365423},
url = {https://www.medrxiv.org/content/10.64898/2026.10.17.26365423v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Claims-based reconstruction of the pancreatic cancer care pathway links centralization of care to survival
AU - D. Laubr
AU - A. Tichopad
AU - M. Rybar
AU - Z. Bielcikova
AU - M. Lovecek
AU - M. Rozanek
AU - G. Donin
PY - 2026
DA - 2026/10/17
PB - medRxiv
DO - 10.64898/2026.10.17.26365423
UR - https://www.medrxiv.org/content/10.64898/2026.10.17.26365423v1
AB - BackgroundThe organization of pancreatic cancer care may be associated with survival. Using health administrative claims data, we reconstructed the pathway from diagnosis to first-line therapy and examined associations of multidisciplinary team review and treatment at specialized centers with overall survival. MethodsLongitudinal historical cohort study using anonymized health administrative claims data from six Czech health insurance funds, covering approximately 17% of patients diagnosed with pancreatic cancer nationally between 2018 and 2020. Adults with an incident ICD-10 C25 record confirmed by imaging and histopathology were followed from the index date (the date of the first qualifying imaging or histopathological examination) until death, censoring, or 31 December 2021. Overall survival was analyzed using Kaplan-Meier methods and Cox regression adjusted for age and first-line therapy type. ResultsOf 1,255 patients, 920 (73.3%) received first-line therapy and 266 (21.2%) died untreated. Among treated patients, 436 (47.4%) underwent multidisciplinary team review, 335 (36.4%) underwent surgery, and 667 (72.5%) were treated at a complex oncological center. Surgery was associated with longer overall survival than chemotherapy (age-adjusted hazard ratio [HR] 0.32, P < 0.001). Treatment at a complex oncological center was associated with longer overall survival (adjusted HR 0.77, 95% confidence interval [CI] 0.64-0.92, P = 0.004; crude median 532 versus 394 days). Multidisciplinary team review was not significantly associated with overall survival (adjusted HR 0.86, 95% CI 0.73-1.01, P = 0.073). ConclusionsTreatment at a complex oncological center was associated with longer survival, while fewer than half of patients had a recorded multidisciplinary team review. How care is organized, not only which therapy is delivered, is associated with outcome. The observational design and absence of key clinical covariates limit causal interpretation.
ER -