Table 2.
Summary of the evidence for examined significant predictors, on multivariable analysis, of chemotherapy utilisation
| Predictor variables | Chemotherapy | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
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| Neoadjuvant chemotherapy only (2 studies) [27,28] | Neoadjuvant and adjuvant chemotherapy (5 studies) [25,27,35-37] | Adjuvant chemotherapy only (6 studies) [29-34] | Palliative Chemotherapy (i.e. chemotherapy provided to stage IV/inoperable patients) (8 studies) [22,29,35,38-42] | Chemotherapy in last 14 days of life (2 studies) [69,73] | ||||||
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| No. of studies* | Direction | No. of studies* | Direction | No. of studies* | Direction | No. of studies* | Direction | No. of studies* | Direction | |
| Patient demographic characteristics | ||||||||||
| Age | 1/2 | ↓Older (ref: younger) | 5/5 | ↓Older (ref: younger) | 5/5 | ↓Older (ref: younger) | 8/8 | ↓Older (ref: younger) | 2/2 | ↓Older (ref: younger) |
| Sex | 0/1 | n/a | 1/5 | ↑F (ref: M) | 1/5 | ↓F (ref: M) | 1/6 | ↓F (ref: M) | 1/2 | ↓F (ref: M) |
| Race/ethnicity | 1/1 | ↓missing/other (ref: Caucasian) | 4/5 | ↓African American or Hispanic (ref: Caucasian) | 2/3 | Variable | 3/4 | Variable | 0/1 | n/a |
| 1/2: ↓African American (ref: Caucasian) | 1/2: ↓African American (ref: Caucasian) | |||||||||
| 1/2: ↓other (ref: Caucasian) | 1/2: ↓unknown (ref: African American) | |||||||||
| Education | 0/1 | n/a | 2/2 | ↑most educated area (ref: least educated area) | ||||||
| Income | 0/1 | n/a | 1/1 | ↑highest (ref: lowest) | 1/1 | ↑highest (ref: lowest) | 1/1 | ↑highest (ref: lowest) | ||
| Insurance | 2/2 | Variable | 2/2 | Variable | 1/1 | ↑non-Medicare/Medicaid, | ||||
| 1/2: ↑Private, Medicare or Medicaid (ref: uninsured) | ↑insured (ref: uninsured) | ↓no insurance (ref: Medicaid) | ||||||||
| 1/2: ↓Medicare (ref: private) | 1/2: ↑Medicare (ref: uninsured) | |||||||||
| SES | 1/1 | ↓low SES (ref: high SES) | 5/5 | ↓low SES (ref: high SES) | 1/1 | ↓low SES (ref: high SES) | ||||
| Location of residence | 0/1 | n/a | 1/2 | ↓outer regional (ref: major city) | 0/2 | n/a | ||||
| Marital status | 1/2 | ↑married (ref: single) | 1/1 | ↑married (ref: unmarried) | 1/1 | ↑married (ref: unmarried) | ||||
| Disease characteristics | ||||||||||
| TNM/ACJJ stage | 1/2 | ↑stage II (ref: stage I) | 3/3 | ↑stage II or III (ref: stage I) | 0/1 | n/a | 1/1 | ↑stage II or IV (ref: stage I) | ||
| Tumour site | 1/2 | ↓body, tail or other/NOS (ref: head) | 3/4 | ↑body/tail (ref: head) | 1/1 | ↑other (ref: head) | ||||
| Tumour size | 1/1 | ↑2-4 cm (ref: <2 cm) | ||||||||
| Grade/differentiation | 0/2 | n/a | 0/1 | n/a | ||||||
| Histology | 1/1 | ↓no histology (ref: adenocarcinoma) | ||||||||
| Nodal status | 2/2 | ↑N1 (ref: N0) | ||||||||
| Metastasis | 1/1 | ↑no vascular invasion (ref: vascular invasion) | 1/1 | ↑lymph node mets (ref: no lymph node mets) | 1/2 | ↓≥2 sites or unknown (ref: 1 site) | ||||
| T stage | 1/1 | ↑T2 or T3 (ref: T1) | ||||||||
| N stage | ||||||||||
| SEER stage | ||||||||||
| CCI/Charlson-Deyo Score | 0/1 | n/a | 2/2 | ↓increasing CCI (ref: CCI 0) | 3/3 | Variable | 2/4 | ↓increasing CCI (ref: CCI 0) | 0/2 | n/a |
| ↓CCI 1 or 2 (ref: CCI: 0) | ||||||||||
| ↓CCI: 2 (ref: CCI: 0) | ||||||||||
| ↓increasing CCI (ref: CCI: 0) | ||||||||||
| Performance status | 1/1 | ↓in bed/bedbound (ref: fully active) | ||||||||
| Year of death | 0/1 | n/a | ||||||||
| Treatment characteristics | ||||||||||
| Year of diagnosis/treatment | 1/1 | ↑post-2004 (ref: 2004) | 3/4 | ↑per year increase (ref: lowest year) | 1/1 | ↑post-2008 (ref: 2008) | 5/5 | ↑per year increase (ref: lowest year) | 0/1 | n/a |
| MDT presentation | 1/1 | ↑Yes (ref: no) | ||||||||
| Primary care | 0/1 | n/a | ||||||||
| Radiotherapy | 1/1 | ↓Yes (ref: no) | ||||||||
| Stent | 1/1 | ↓Yes (ref: no) | ||||||||
| Surgery | 0/2 | n/a | ||||||||
| Palliative care | 1/1 | ↓Yes (ref: no) | ||||||||
| Health service characteristics | ||||||||||
| Hospital type | 1/2 | ↑teaching, comprehensive, NCI or other (ref: community) | 1/1 | ↑teaching, comprehensive, NCI or other (ref: community) | 1/2 | ↓Academic (ref: non-academic) | ||||
| Hospital volume (i.e. case load per year) | 1/1 | ↑≥15 (ref: <15) | 1/1 | ↑Lowest procedure volume (ref: highest procedure volume) | 1/2 | ↑treated at high volume incidence centre (ref: not treated at high volume incidence centre) | ||||
*
Number of studies = Studies with significant findings in relation to the predictor variable (numerator)/total number of studies evaluating the predictor variable (denominator).
Abbreviations: AJCC, American Joint Committee on Cancer; CCI, Charlson Comorbidity Index; EUS, endoscopic ultrasound; ICU, Intensive Care Unit; MDT, Multidisciplinary team meeting; NCI, National Cancer Institute designated centre; Ref, Reference; SEER, Surveillance, Epidemiology and End-Results; SES, Socioeconomic status; TNM, Tumour, Node, Metastasis staging system.