Treatment patterns and survival in patients with early-onset pancreatic cancer Journal Article
| Authors: | Saadat, L. V.; Chou, J. F.; Gonen, M.; Soares, K. C.; Kingham, T. P.; Varghese, A. M.; Jarnagin, W. R.; D’Angelica, M. I.; Drebin, J. A.; O’Reilly, E. M.; Wei, A. C. |
| Article Title: | Treatment patterns and survival in patients with early-onset pancreatic cancer |
| Abstract: | Background: Pancreatic cancer is uncommon in patients younger than 50 years, although its incidence is increasing. This study characterizes treatment utilization for early-onset pancreatic cancer (EOPC) versus average-age-onset pancreatic cancer (AOPC) and identifies factors associated with failure to receive treatment. Methods: The National Cancer Data Base (NCDB) was queried for patients with EOPC (age < 50 years) or AOPC (age ≥ 50 years) from 2004 to 2016. Multinomial regression was used to compare utilization (single modality vs multimodal treatment with or without surgery vs no treatment) between EOPC and AOPC. Kaplan-Meier methods were used to estimate overall survival (OS). Results: Of 248,634 patients, 15,710 (6.3%) had EOPC. There were more male patients (56% vs 50%), non-White patients, and privately insured patients (61% vs 30%) with EOPC versus AOPC, without notable differences in clinical stage distribution. Patients with EOPC received more chemotherapy (38% vs 29%), surgery (9% vs 6.9%), chemoradiation (12% vs 9.2%), and multimodal treatment (21% vs 15%). The odds of receiving multimodal curative therapy were significantly higher for patients with EOPC versus patients with AOPC after adjustments for confounders (odds ratio, 3.89; 95% confidence interval [CI], 3.66-4.15; P <.001). Nineteen percent of patients with EOPC, in contrast to 39% of patients with AOPC, received no treatment. Patients with AOPC more frequently declined chemotherapy (15% vs 9.5%). One-year OS was higher for EOPC versus AOPC across each stage (0/I/II, 72% [95% CI, 71%-74%] vs 53% [95% CI, 53%-54%]; III, 48% [95% CI, 45%-50%] vs 38% [95% CI, 37%-38%]; IV, 25% [95% CI, 24%-26%] vs 15% [95% CI, 15%-15%]) and treated patients (0/I/II, 75% [95% CI, 74%-77%] vs 64% [95% CI, 63%-64%]; III, 51% [95% CI, 49%-54%] vs 47% [95% CI, 47%-48%]; IV, 29% [95% CI, 28%-31%] vs 23% [95% CI, 23%-24%]). Conclusions: Patients with EOPC receive more oncologic therapy than patients with AOPC, although the intensity, type, and duration of chemotherapy are not available in the NCDB; however, 19% and 39%, respectively, receive no therapy. Underutilization may explain suboptimal oncologic outcomes. Efforts to improve access and treatment utilization in all age groups are warranted. © 2021 American Cancer Society. |
| Keywords: | survival; adult; cancer survival; treatment outcome; young adult; major clinical study; overall survival; treatment duration; pancreas cancer; pancreatic neoplasms; treatment; cohort analysis; retrospective study; chemoradiotherapy; utilization; human; male; female; article; young onset |
| Journal Title: | Cancer |
| Volume: | 127 |
| Issue: | 19 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 2021-10-01 |
| Start Page: | 3566 |
| End Page: | 3578 |
| Language: | English |
| DOI: | 10.1002/cncr.33664 |
| PUBMED: | 34228820 |
| PROVIDER: | scopus |
| PMCID: | PMC8711090 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 October 2021 -- Source: Scopus |
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