| Sumario: | Simple Summary: Pancreatic cancer treatment often requires coordinated systemic therapy, but national data rarely show how specialist-team availability relates to treatment processes. We used nationwide data from the Center for Cancer Genomics and Advanced Therapeutics (C-CAT) to compare facilities with 0–1 versus ≥2 registry-listed Japanese Society of Medical Oncology (JSMO) specialists. The analysis focused on time from systemic therapy start to recorded first-line treatment end. Among 14,568 patients at 261 facilities, median recorded first-line treatment-process duration was 5.7 months at facilities with 0–1 specialists and 6.4 months at facilities with ≥2 specialists; the association persisted after clinical and facility adjustment. Supportive overall survival did not support a corresponding survival advantage. These results show a facility-level association in registry-derived treatment-process data, not direct specialist involvement, treatment efficacy, facility quality, causality, or survival benefit. Chemotherapy-specific national database elements are needed for direct evaluation. Facility-level availability of Japanese Society of Medical Oncology (JSMO) specialists may influence care processes, but national cancer genomic medicine data rarely capture patient-level specialist involvement. We conducted a nationwide retrospective analysis of pancreatic cancer cases in the Center for Cancer Genomics and Advanced Therapeutics (C-CAT). The primary exposure was facility-level registry-listed JSMO specialist count (0–1 vs. ≥2 specialists), with ≥2 interpreted as a proxy for minimum plural specialist-team availability. The primary endpoint was time from systemic therapy start to recorded first-line treatment end. The primary cohort included 14,568 patients at 261 facilities. Median recorded first-line treatment-process duration was 5.7 months in the 0–1 specialist group and 6.4 months in the ≥2 specialist group. In the clinical plus facility-adjusted Cox model, ≥2 specialist availability was associated with a lower hazard of recorded first-line treatment end (HR 0.895, 95% CI 0.810–0.988; p = 0.028). Supportive overall survival findings did not indicate a survival advantage, reinforcing the operational nature of the primary endpoint. These findings indicate a facility-level association with an operational treatment-process endpoint, not patient-level specialist involvement, treatment efficacy, survival benefit, facility ranking, or causality. Chemotherapy-specific national database elements are needed to evaluate specialist contribution directly.
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