Treatment of elderly patients with pancreatic cancer

Our publication is about elderly patients’ treatment evaluation for pancreatic cancer in the United States. This is a Surveillance, Epidemiology, and End Results (SEER)-Medicare analysis of patients above age of 65 who have Medicare and were treated for pancreatic cancer at all stages of the disease (locoregional and metastatic stages). Cancer care is challenging from the treatment perspective. We evaluated the demographic and clinical determinants of treatment receipt and compared pancreatic cancer survival across patient-, disease-, and treatment-specific groups of Medicare patients with specific focus on their socioeconomic state. Here, we concentrated about possible gaps of care other than insurance, for this population. The mean ages of the largest 2 trials that set the standard of care in metastatic pancreatic cancer ranged between 61 and 65; only 10% of patients were 75 years and older. Clearly, elderly patients are underrepresented in all cancer clinical trials; thus, optimal management is unknown for this population.

Of the 5975 pancreatic cancer patients in the SEER-Medicare link, 74% had locoregional disease. Patients 75 years and older with locoregional and metastatic disease stages appeared not to benefit from conventional treatments like surgery with or without chemotherapy, and palliative chemotherapy. Patients with metastatic disease were half as likely to receive any treatment compared to locoregional disease. In addition, elderly Medicare patients with low socioeconomic status are less likely receive pancreatic cancer treatment.

This study highlights treatment patterns and tried to address possible obstacles to access of care in elderly patients with pancreatic cancer other than insurance coverage (all patients had Medicare). Greater efforts are needed to overcome the barriers and to identify the causes of disparities in care for elderly patients, in general, and specifically for pancreatic cancer where optimal treatments for elderly are not identified.

Walid L Shaib
Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA

Publication

Evaluation of Treatment Patterns and Survival Outcomes in Elderly Pancreatic Cancer Patients: A Surveillance, Epidemiology, and End Results-Medicare Analysis.
Shaib WL, Jones JS, Goodman M, Sarmiento JM, Maithel SK, Cardona K, Kane S, Wu C, Alese OB, El-Rayes BF
Oncologist. 2018 Jun

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