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.

Trends in the Incidence and Treatment of Early-Onset Pancreatic Cancer

“…A recent analysis of 248,634 patients in the National Cancer Data Base (NCDB), a hospital-based database of patients that is not designed to be representative of the US population, found patients with EOPC receive more chemotherapy (38% vs. 29%), surgery (9% vs. 6.9%), chemoradiation (12% vs. 9.2%), and multimodal treatment (21% vs. 15%). This analysis also found that patients with EOPC had a higher one-year overall survival rate across all stages than older patients [ 32 ]. Two single-center reviews of patients with EOPC have also shown differences in the treatment of young patients compared to older patients, with younger patients generally receiving more therapy [ 30 , 33 ].…”

“…The etiology for this lack of treatment is unknown, as single-center analyses of EOPC often do not include information on untreated patients. However, one study suggested that patient insurance status, comorbidity prevalence, proximity to treatment, income, and education level may contribute to lower treatment rates for patients with pancreatic cancer [ 32 ]. Additional evaluation of the population of patients with untreated EOPC is warranted to characterize the reasons for, and barriers to, not pursuing treatment.…”

Practical Considerations in Diagnosing and Managing Early-Onset GI Cancers

“…82,83 Epidemiology and Risk Factors Among patients with EO-PC compared with AO-PC, there are a higher proportion of males and a higher proportion of non-White, composed of a mix of Black, Asian, and Hispanic individuals. 84,85 Data from the WHO mortality database from 1995 to 1999 also demonstrated a higher incidence of EO-PC in males and found that the highest PC rate ratios were found in Central/Eastern European countries (2.4-4.5 for males and 1.6-4.3 for females). 80 Several other studies have corroborated the male predominance of EO-PC.…”

A Path Forward for Understanding and Addressing Multifaceted Pancreatic Cancer Disparities

“…6,7 Possible reasons cited for the rise in EOPC among non-Hispanic White and Hispanic women include increases in body mass index, increased access to diagnostic imaging, detection of certain histologic subtypes (ie, cystic adenocarcinomas) that are more common in women, 5,6 and sex-based differences in exposure to known or unknown agents and risk factors, including estrogen. 7,8 Using retrospective data from the National Cancer Database, Saadat et al 9 explored treatment patterns for patients with EOPC diagnosed from through 2016. The analysis revealed that nearly 20% of patients with EOPC did not receive any therapy, representing a significant missed opportunity for guideline-concordant care for this historically underrepresented group.…”