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Pancreatic Cancer in the USA: Persistence of Undertreatment and Poor Outcome

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Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Purpose

Despite decades of research, consensus on optimal treatment for pancreatic cancer has not been reached and survival remains bleak. This study aimed to evaluate predictors of treatment and survival among patients treated in community settings.

Methods

A sample of pancreatic cancer patients who were diagnosed in 2009 and reported to the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program (n = 977) was included. Logistic regression was used to assess factors associated with therapy modality. Survival was examined using the Kaplan-Meier method and Cox proportional hazards regression. All analyses were conducted stratified by tumor stage.

Results

Among stages I–II patients, 27 % received no treatment and only 47 % received surgery. Among these patients, no treatment was associated with older age, being a woman, not being married, lower income, and larger or unknown tumor size. Additionally, the type of adjuvant therapy received varied by tumor characteristics, race/ethnicity, and socioeconomic status. The most common therapies for stage III tumors were chemoradiation (40.8 %) and chemotherapy (21.9 %) alone. Half of stage IV patients received chemotherapy; chemotherapy was less common in patients who were older, in a minority race/ethnicity, and not married. Although treatment was associated with better prognosis, even among stages I–II patients who underwent surgery, a quarter succumbed to their disease within 17 months.

Conclusion

A significant proportion of pancreatic cancer patients remain undertreated primarily due to nonclinical factors, including marital status. Further investigating what aspects of marriage are contributing to this association will provide a better understanding of pancreatic cancer treatment barriers.

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Abbreviations

API:

Asian-Pacific Islanders

CI:

Confidence interval

HR:

Hazard ratio

ICD-O3:

International Classification of Diseases for Oncology 3rd edition

NCI:

National Cancer Institute

OR:

Odds ratio

POC:

Patterns of care

SEER:

Surveillance Epidemiology and End Results

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Authors and Affiliations

  1. Applied Research Program, National Cancer Institute, 9609 Medical Center Drive, Room 3E506, Bethesda, MD, 20892-9762, USA

    Lindsey Enewold & Linda C Harlan

  2. University of Kentucky Cancer Control Program, 2365 Harrodsburg Road, Lexington, KY, 40504-3381, USA

    Thomas Tucker & Shaun McKenzie

Authors
  1. Lindsey Enewold
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  2. Linda C Harlan
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  4. Shaun McKenzie
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Correspondence to Lindsey Enewold.

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Enewold, L., Harlan, L.C., Tucker, T. et al. Pancreatic Cancer in the USA: Persistence of Undertreatment and Poor Outcome. J Gastrointest Canc 46, 9–20 (2015). https://doi.org/10.1007/s12029-014-9668-x

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