Markov decision analysis of neoadjuvant treatment pathway versus surgery first pathway for resectable pancreatic cancer

Alison Bradley, Colin J McKay, Nigel B Jamieson, Euan J Dickson, Ross Carter, Robert Van Der Meer

Research output: Contribution to conferencePoster

22 Downloads (Pure)

Abstract

Background:
Surgery first (SF) versus neoadjuvant approach (NAT) to management of potentially resectable pancreatic ductal adenocarcinoma (PDAC) is controversial. This study is unique in utilizing institutional data to offer Markov decision-analysis of overall treatment pathways for resectable PDAC.

Methods:
An advanced Markov decision analysis model was constructed and populated with data from a retrospective institutional database. Patients presenting with resectable PDAC from 2008-2012 were included in the SF arm. Those presenting with resectable PDAC from 2012-2016 and treated within NAT pathway populated the NAT arm. Model uncertainties were tested with one and two-way deterministic sensitivity analysis and probabilistic Monte Carlo sensitivity analysis set to 1000 cycles with variables altered between highest and lowest observed values.

Results:
NAT pathway gave an additional 0.58 QALMs (22.43 vs. 21.85 QALMs). Monte Carlo analysis reported indifference between treatment strategies. One-way deterministic sensitivity analysis showed that probability of resection in the SF pathway must be greater than 0.82, or below 0.72 in NAT pathway, and probability of receiving adjuvant therapy above 0.6 to alter pathway superiority. Two-way deterministic sensitivity analysis demonstrated treatment superiority depended on resection rate in each pathway and receiving adjuvant therapy in SF pathway. Markov cohort analysis demonstrated superiority of neoadjuvant pathway (Table).

Conclusions:
Optimal treatment pathway remains debatable on an intention-to-treat Markov decision analysis. Markov cohort analysis of treatment received demonstrated benefit with NAT pathway.
Original languageEnglish
Number of pages1
Publication statusPublished - 18 Jan 2018
Event2018 Gastrointestinal Cancers Symposium: Multidisciplinary Care: Local Practice, Global Outcomes - Moscone West Building, San Francisco, United States
Duration: 18 Jan 201820 Jan 2018
https://gicasym.org/

Conference

Conference2018 Gastrointestinal Cancers Symposium
Abbreviated titleASCO GI 2018
CountryUnited States
CitySan Francisco
Period18/01/1820/01/18
Internet address

Keywords

  • Markov decision analysis
  • pancreatic cancer
  • neoadjuvant treatment
  • resectable cancer

Projects

Research Output

  • 1 Meeting abstract

Markov decision analysis of neoadjuvant treatment pathway versus surgery first pathway for resectable pancreatic cancer

Bradley, A., McKay, C. J., Jamieson, N. B., Dickson, E. J., Carter, R. & Van Der Meer, R., 26 Feb 2018, In : Journal of Clinical Oncology. 36, 4 suppl, p. 456 1 p.

Research output: Contribution to journalMeeting abstract

Open Access
File
8 Downloads (Pure)

Activities

  • 1 Invited talk

Management Science Modelling of Healthcare Systems

Robert van der Meer (Invited speaker), Gillian Hopkins Anderson (Contributor) & Alison Bradley (Contributor)

20 Aug 2018

Activity: Talk or presentation typesInvited talk

Cite this

Bradley, A., McKay, C. J., Jamieson, N. B., Dickson, E. J., Carter, R., & Van Der Meer, R. (2018). Markov decision analysis of neoadjuvant treatment pathway versus surgery first pathway for resectable pancreatic cancer. Poster session presented at 2018 Gastrointestinal Cancers Symposium, San Francisco, United States.