Use of chemotherapy and radiotherapy in patients with pancreatic cancer in Victoria (2002–2003): a retrospective cohort study

Abstract

Objective: To describe the management and outcomes of a population‐based cohort of patients with pancreatic cancer treated with chemotherapy or radiotherapy in Victoria, Australia. Design, setting and patients: Questionnaire‐based study of patients diagnosed with pancreatic cancer during 2002–2003 in Victoria who were retrospectively identified from the Victorian Cancer Registry and followed up for a minimum of 5 years. Main outcome measures: Reported treatment, referral patterns and survival rates. Results: 1044 patients with pancreatic cancer were identified, of whom 927 were eligible for the study. Completed questionnaires were obtained for 831 eligible patients (response rate, 89.6%) and data for 66 patients with tumours of the ampulla of Vater and neuroendocrine tumours were excluded. Of the remaining 765 patients, 6.5% were managed in multimodality clinics. Chemotherapy was considered for 413 patients and radiotherapy was considered for 162. One‐third of the cohort (275 patients) received chemotherapy, most commonly as palliative treatment (185). Single‐agent gemcitabine was the most common palliative treatment (154), and was associated with a median overall survival of 6.6 months. Radiotherapy was used in 119 patients (15.6% of the cohort) — it was used alone or with chemotherapy, as postoperative adjuvant treatment, as potentially curative radical treatment, or as palliative treatment. For 45 patients with locally advanced disease who were treated with chemoradiation as radical treatment, median overall survival was 13.1 months. Conclusions: There appears to be under‐referral of patients to medical and radiation oncologists. Median survival of patients treated with radical chemoradiation or palliative chemotherapy is consistent with clinical trial data, but outcomes for patients in our cohort were generally poor. Development and implementation of treatment guidelines may result in improved outcomes.

Use and outcomes of chemotherapy for metastatic pancreatic cancer in Australia

“…The proportion of patients for whom chemotherapy is prescribed has increased in recent years in our state. A Victorian study of patients treated between 2002 and 2003 observed that 185 of 578 (32%) of patients with advanced disease had received palliative chemotherapy, 11 compared with 54% in our study (2016–2019). In the 2002–2003 study, 15% of patients initially considered for chemotherapy did not proceed with treatment, the major contributing reason being patients declining the offered treatment, followed by disease progression and functional decline.…”

“…Furthermore, neither olaparib in the maintenance setting nor nanoliposomal irinotecan in the second‐line setting is currently reimbursed in Australia. Prior to the advent of combination regimens, chemotherapy was prescribed in only one‐third of patients in our state, Victoria 11 . Our study seeks to establish current practice in Australia and subsequent survival outcomes.…”

Volume matters in the systemic treatment of metastatic pancreatic cancer: a population-based study in the Netherlands

“…One Australian cohort observed that 43 % of the patients received palliative chemotherapy; however, this was a smaller study with 1863 patients and selection bias may have occurred (Burmeister et al 2015 ). A second Australian study by Jefford et al ( 2010 ) reported 54 % chemotherapy use, but analyzed both resectable and irresectable patients. A recent study by Oberstein et al ( 2013 ) seems to report a considerably higher percentage of patients treated with palliative chemotherapy (54 %).…”

Patterns of Chemotherapy Use in a U.S.-Based Cohort of Patients with Metastatic Pancreatic Cancer

“…Few studies have examined administration frequencies of specific chemotherapeutic regimens and the predictors of their usage in MPC . Existing literature consists of research conducted in limited practice settings or studies with data derived from retrospective medical record extraction , patient and physician surveys , or insurance claims to ascertain use . To understand factors influencing treatment decisions, we analyzed data from a nationwide, commercially available chemotherapy order entry (COE) system that provided tumor stage, disease status and treatment indication.…”