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Cindy Tran, Brittany Pike, Matthew Kendra, Rachelle Mirkin and Judith J. Prochaska

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Rebecca Arend, Brandon M. Roane, Selene Mesa-Perez, Whitney N. Goldsberry, Ashwini Katre, Michael J. Birrer and Lisa A. Norian

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Hanyu Chen, Jie Liu, Xiaoyu Zong, Ai Zhang, Jennifer Tappenden, Thomas Walsh, Deyali Chatterjee, Ryan Courtney Fields, Graham Andrew Colditz and Yin Cao

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Tim Luetkens, Sabarinath Venniyil Radhakrishnan, Sandra D. Scherer, Patricia Davis, Erica R. Vander Mause, Michael L. Olson, Sara Yousef, Jens Panse, Yasmina Abdiche, K. David Li, Rodney R. Miles, William Matsui, Alana L. Welm and Djordje Atanackovic

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Nancy Danielle Ebelt, Edith Zuniga and Edwin Ramos Manuel

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Elizabeth Stewart, Kaley Blankenship, Lauren Hoffmann and Burgess Freeman

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Julie Hallet, Laura Davis, Alyson Mahar, Michail Mavros, Kaitlyn Beyfuss, Ying Liu, Calvin H.L. Law, Craig Earle and Natalie Coburn

Background: Although pancreatic adenocarcinoma (PA) surgery performed by high-volume (HV) providers yields better outcomes, volume–outcome relationships are unknown for medical oncologists. This study examined variation in practice and outcomes in noncurative management of PA based on medical oncology provider volume. Methods: This population-based cohort study linked administrative healthcare datasets and included nonresected PA from 2005 through 2016. The volume of PA consultations per medical oncology provider per year was divided into quintiles, with HV providers (≥16 patients/year) constituting the fifth quintile and low-volume (LV) providers the first to fourth quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). The Brown-Forsythe-Levene (BFL) test for equality of variances was performed to assess outcome variability between provider-volume quintiles. Multivariate regression models were used to examine the association between management by HV provider and outcomes. Results: A total of 7,062 patients with noncurable PA consulted with medical oncology providers. Variability was seen in receipt of chemotherapy and median survival based on provider volume (BFL, P<.001 for both), with superior 1-year OS for HV providers (30.1%; 95% CI, 27.7%–32.4%) compared with LV providers (19.7%; 95% CI, 18.5%–20.6%) (P<.001). After adjustment for age at diagnosis, sex, comorbidity burden, rural residence, income, and diagnosis period, HV provider care was independently associated with higher odds of receiving chemotherapy (odds ratio, 1.19; 95% CI, 1.05–1.34) and with superior OS (hazard ratio, 0.79; 95% CI, 0.74–0.84). Conclusions: Significant variation was seen in noncurative management and outcomes of PA based on provider volume, with management by an HV provider being independently associated with superior OS and higher odds of receiving chemotherapy. This information is important to inform disease care pathways and care organization. Cancer care systems could consider increasing the number of HV providers to reduce variation and improve outcomes.