Uptake and Patterns of Use of Gemcitabine for Metastatic Pancreatic Cancer: A Population-Based Study

Oberstein, Paul E.; Hershman, Dawn L.; Khanna, Lauren G.; Chabot, John A.; Insel, Beverly J.; Neugut, Alfred I.

doi:10.3109/07357907.2013.789904

Cited by 22 publications

(29 citation statements)

References 38 publications

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“…Most previous observational studies only included patients with microscopically confirmed pancreatic cancer [5,11,13,21,22,32]. Although pathologic confirmation of pancreatic cancer prior to chemotherapy is strongly recommended [27,33], one in ten of treated patients in our study started chemotherapy without prior microscopic tumor verification.…”

Section: Discussionmentioning

confidence: 93%

Nationwide trends in chemotherapy use and survival of elderly patients with metastatic pancreatic cancer

Geest¹,

Mohammad²,

Besselink³

et al. 2017

European Journal of Cancer

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Despite an aging population and underrepresentation of elderly patients in clinical trials, studies on elderly patients with metastatic pancreatic cancer are scarce. This study investigated the use of chemotherapy and survival in elderly patients with metastatic pancreatic cancer. From the Netherlands Cancer Registry, all 9407 patients diagnosed with primary metastatic pancreatic adenocarcinoma in 2005-2013 were selected to investigate chemotherapy use and overall survival (OS), using Kaplan-Meier and Cox proportional hazard regression analyses. Over time, chemotherapy use increased in all age groups (<70 years: from 26 to 43%, 70-74 years: 14 to 25%, 75-79 years: 5 to 13%, all P < 0.001, and ≥80 years: 2 to 3% P = 0.56). Median age of 2,180 patients who received chemotherapy was 63 years (range 21-86 years, 1.6% was ≥80 years). In chemotherapy-treated patients, with rising age (<70, 70-74, 75-79, ≥80 years), microscopic tumor verification occurred less frequently (91-88-87-77%, respectively, P = 0.009) and OS diminished (median 25-26-19-16 weeks, P = 0.003). After adjustment for confounding factors, worse survival of treated patients ≥75 years persisted. Despite limited chemotherapy use in elderly age, suggestive of strong selection, elderly patients (≥75 years) who received chemotherapy for metastatic pancreatic cancer exhibited a worse survival compared to younger patients receiving chemotherapy. Cancer Medicine Open Access 2841

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Section: Discussionmentioning

confidence: 93%

Nationwide trends in chemotherapy use and survival of elderly patients with metastatic pancreatic cancer

Geest¹,

Mohammad²,

Besselink³

et al. 2017

European Journal of Cancer

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“…One possible explanation for that finding is the cumulative effect of gradual increases in chemotherapy uptake in the palliative setting 29 . Use of recently developed chemotherapy regimens such as folfirinox (approved in Ontario in 2011) continues to increase for pcc patients 30 , and survival for individuals diagnosed after 2011 is expected to reflect the effect of those regimens.…”

Section: Discussionmentioning

confidence: 99%

A Population-Based Study of the Epidemiology of Pancreatic Cancer: A Brief Report

et al. 2015

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Objective Administrative data are used to describe the pancreatic cancer (pcc) population. The analysis examines demographic details, incidence, site, survival, and factors influencing mortality in a cohort of individuals diagnosed with pcc.Methods Incident cases of pcc diagnosed in Ontario between 1 January 2004 and 31 December 2011 were extracted from the Ontario Cancer Registry. They were linked by encrypted health card number to several administrative databases to obtain demographic and mortality information. Descriptive, bivariate, and survival analyses were conducted.Results During the period of interest, 9221 new cases of pcc (4548 in men, 4673 in women) were diagnosed, for an age-adjusted standardized annual incidence in the range of 8.6-9.5 per 100,000 population. Mean age at diagnosis was 70.3 ± 12.5 years (standard deviation). Five-year survival was 7.2% (12.8% for those <60 years of age and 3.6% for those >80 years of age). Survival varied by sex, older age, rural residence, lower income, site of involvement in the pancreas, and presence of comorbidity. ConclusionsThe mortality rate in pcc is exceptionally high. With an increasing incidence and a mortality positively associated with age, additional support will be needed for this highly fatal disease as demographics in Ontario continue to trend toward a higher proportion of older individuals.

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“…Furthermore, elderly patients remain poorly represented in clinical trials 5 and are often not recommended for standard therapy. 6,7 Hutchins et al demonstrated that patients 65 years or older were significantly underrep-resented in the Southwest Oncology Group treatment trials, which included trials specifically for pancreas cancer. 5 In another study, 11% of physicians explicitly reported that age was a reason for not enrolling elderly patients in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

“…8 In terms of standard therapy, Oberstein et al investigated the Surveillance, Epidemiology, and End Results-Medicare database for patients with metastatic pancreas adenocarcinoma diagnosed between 1998 and 2005 and demonstrated that the likelihood of receipt of palliative gemcitabine decreased with advancing age. 7 Additionally, Vijayvergia et al also reported differences in patterns of care and outcomes of elderly versus younger patients with metastatic pancreatic cancer. Specifically, the authors showed at their institution that older patients (> 65 years of age) despite having similar performance status and disease characteristics were less likely to receive any chemotherapy and if treated were less likely to receive more than 1 chemotherapy agent.…”

Section: Introductionmentioning

confidence: 99%

Treatment, Outcomes, and Clinical Trial Participation in Elderly Patients With Metastatic Pancreas Adenocarcinoma

Capanu

et al. 2015

Clinical Colorectal Cancer

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Studies on the treatment patterns and outcomes of elderly patients with metastatic pancreas cancer remain limited. Therefore, an analysis of systemic therapy use, clinical trial participation, and outcomes in elderly patients with metastatic pancreas cancer was performed at our institution. Elderly patients who received systemic therapy had a longer survival compared with those who did not. However, therapeutic clinical trial participation was low and should be encouraged Background Pancreas adenocarcinoma has a median age at diagnosis of 71 years. Limited studies have focused on the treatment of elderly patients with pancreas cancer. Patients and Methods An analysis of systemic therapy use, clinical trial participation, and overall outcomes of 237 patients with metastatic pancreas adenocarcinoma ≥ 75 years of age evaluated at Memorial Sloan-Kettering Cancer Center between 2005 and 2013 was undertaken. Results Median overall survival was 7 months for the entire study population. A total of 197 (83%) patients received systemic therapy, which was significantly associated with longer overall survival (P < .01). No significant difference was detected in survival between age groups 75 to 79, 80 to 84, and ≥ 85 years of age among those who received systemic therapy (P = .49). Seventy-seven (32%) patients participated in a clinical trial of whom 13 (5%) patients were enrolled in a therapeutic trial, including no patients aged ≥ 85 years. Multivariate analysis demonstrated that presence of liver metastases (P < .001), performance status (P < .001), and number of systemic agents (P < .001) were significantly associated with survival. Conclusion Receipt of systemic therapy was associated with longer survival in elderly patients ≥ 75 years of age with metastatic pancreas adenocarcinoma. Therapeutic clinical trial participation among these patients was low and future development of prognostic models for appropriate patient selection is warranted.

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Uptake and Patterns of Use of Gemcitabine for Metastatic Pancreatic Cancer: A Population-Based Study

Cited by 22 publications

References 38 publications

Nationwide trends in chemotherapy use and survival of elderly patients with metastatic pancreatic cancer

Nationwide trends in chemotherapy use and survival of elderly patients with metastatic pancreatic cancer

A Population-Based Study of the Epidemiology of Pancreatic Cancer: A Brief Report

Treatment, Outcomes, and Clinical Trial Participation in Elderly Patients With Metastatic Pancreas Adenocarcinoma

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