Centralization of specialist services to urban centres presents a challenge to patients living in rural communities. The Hepatopancreatobiliary Surgery (HPB) program at Health Sciences North (HSN) is the 10th and newest designated HPB centre by Cancer Care Ontario, and presents a unique opportunity to evaluate the impact and barriers to delivering HPB cancer care to patients in Northern Ontario. A retrospective review was completed on all patients referred to the Northeastern Ontario Cancer Centre and those seen at Health Sciences North with a new diagnosis of pancreatic cancer between 2009 and 2015. Interventions were consultations to HPB surgical specialists, consultations with medical oncologists, and operative management. The primary outcome was time from diagnosis to HPB surgical consultation. Secondary outcomes included distance travelled for surgical consultation, surgical intervention, time from surgical consultation to operation and time from diagnosis to medical oncology consultation. We compare referral patterns and management of pancreatic malignancies before and after July 2013, which marks the inception of the HPB program. A total of 207 patients with a new diagnosis of pancreatic cancer were reviewed from 2009 to 2015. The HPB program resulted in significantly shorter wait times to HPB surgical consultation, and shorter distances to travel for consultation and surgery. The proportion of pancreatic malignancies receiving HPB surgical consultation increased, with higher rates of definitive and palliative surgical intervention. Patients were able to receive complex pancreatic surgeries, closer to their home region. No statistically significant changes were noted in time to see medical oncology and time to operation in our study. The development of an HPB program in the North East Local Health Integration Network appears to have increased the number of patients undergoing HPB surgical consultation and treatment for pancreatic malignancies, and decreased the time to consultation and distance of travel for care. It is anticipated these changes may impact overall outcomes with increased accessibility, quality of care and patient satisfaction, and this will be the focus of future investigations.

Impact of a Hepatopancreatobiliary Program on Management of Pancreatic Cancer at Health Sciences North