Richard Li1, Jessica Vazquez1, Jennifer Novak1, Mina Sedrak2, Susanne Warner3, Scott Glaser1, Yi-Jen Chen1, William Dale4, Arya Amini5. 1. Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, United States of America. 2. Department of Medical Oncology, City of Hope Medical Center, Duarte, CA, United States of America. 3. Department of Surgical Oncology, City of Hope Medical Center, Duarte, CA, United States of America. 4. Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, CA, United States of America. 5. Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, United States of America. Electronic address: aamini@coh.org.
Abstract
INTRODUCTION: Older adults are underrepresented in landmark trials that determine treatment guidelines for pancreatic cancer. We used the National Cancer Database (NCDB) to compare treatment patterns and outcomes in stage I-III pancreatic cancer between older adult patients, defined as age 80 or older, to patients younger than 80. MATERIAL AND METHODS: We identified 140,678 patients in the NCDB diagnosed with pancreatic cancer from 2004 to 2015. Patients with metastatic disease or non-adenocarcinoma histologies were excluded. Descriptive statistics comparing patients age 80+ and age <80 were generated. Logistic regression was used to evaluate predictors of cancer-directed therapy receipt (defined as receipt of chemotherapy, radiation, or surgery) in older patients, and Cox proportional hazards modeling was performed to evaluate survival in the older cohort. RESULTS: We identified 140,678 patients with non-metastatic pancreatic cancer, of which 23,395 patients (16.6%) were 80 or older. Among older patients, 44.5% of patients received cancer-directed therapy compared to 78.7% among other patients (p < .001). Older patients had worse 2-year survival at 11.3% versus 27.5% for younger (p < .001). 2-year survivorship decreased further in older patients who received no cancer-directed treatment, at 4.7% compared with 19.5% for older patients receiving treatment (p < .001). After propensity score matching, cancer-directed treatment remained associated with improved survival for older patients (hazard ratio 0.42; 95% confidence interval 0.41-0.43; p < .001). DISCUSSION: Rates of cancer-directed therapy were low in patients age 80+, with 55.5% receiving no therapy. Cancer-directed treatment was associated with an overall survival benefit. Future trials are needed to define optimal treatment paradigms in this population.
INTRODUCTION: Older adults are underrepresented in landmark trials that determine treatment guidelines for pancreatic cancer. We used the National Cancer Database (NCDB) to compare treatment patterns and outcomes in stage I-III pancreatic cancer between older adult patients, defined as age 80 or older, to patients younger than 80. MATERIAL AND METHODS: We identified 140,678 patients in the NCDB diagnosed with pancreatic cancer from 2004 to 2015. Patients with metastatic disease or non-adenocarcinoma histologies were excluded. Descriptive statistics comparing patients age 80+ and age <80 were generated. Logistic regression was used to evaluate predictors of cancer-directed therapy receipt (defined as receipt of chemotherapy, radiation, or surgery) in older patients, and Cox proportional hazards modeling was performed to evaluate survival in the older cohort. RESULTS: We identified 140,678 patients with non-metastatic pancreatic cancer, of which 23,395 patients (16.6%) were 80 or older. Among older patients, 44.5% of patients received cancer-directed therapy compared to 78.7% among other patients (p < .001). Older patients had worse 2-year survival at 11.3% versus 27.5% for younger (p < .001). 2-year survivorship decreased further in older patients who received no cancer-directed treatment, at 4.7% compared with 19.5% for older patients receiving treatment (p < .001). After propensity score matching, cancer-directed treatment remained associated with improved survival for older patients (hazard ratio 0.42; 95% confidence interval 0.41-0.43; p < .001). DISCUSSION: Rates of cancer-directed therapy were low in patients age 80+, with 55.5% receiving no therapy. Cancer-directed treatment was associated with an overall survival benefit. Future trials are needed to define optimal treatment paradigms in this population.
Authors: Jonathan J Hue; Katherine Bingmer; Kavin Sugumar; Lee M Ocuin; Luke D Rothermel; Jordan M Winter; John B Ammori; Jeffrey M Hardacre Journal: J Gastrointest Surg Date: 2021-02-25 Impact factor: 3.452
Authors: Rebecca S Meltzer; David A Kooby; Jeffrey M Switchenko; Jashodeep Datta; Darren R Carpizo; Shishir K Maithel; Mihir M Shah Journal: Ann Surg Oncol Date: 2020-11-03 Impact factor: 5.344