The use of adjuvant chemotherapy for pancreatic cancer varies widely between hospitals: a nationwide population‐based analysis

Abstract

Adjuvant chemotherapy after pancreatoduodenectomy for pancreatic cancer is currently considered standard of care. In this nationwide study, we investigated which characteristics determine the likelihood of receiving adjuvant chemotherapy and its effect on overall survival. The data were obtained from the Netherlands Cancer Registry. All patients alive 90 days after pancreatoduodenectomy for M0‐pancreatic cancer between 2008 and 2013 in the Netherlands were included in this study. The likelihood to receive adjuvant chemotherapy was analyzed by multilevel logistic regression analysis and differences in time‐to‐first‐chemotherapy were tested for significance by Mann–Whitney U test. Overall survival was assessed by Kaplan–Meier method and Cox regression analysis. Of the 1195 patients undergoing a pancreatoduodenectomy for pancreatic cancer, 642 (54%) patients received adjuvant chemotherapy. Proportions differed significantly between the 19 pancreatic centers, ranging from 26% to 74% (P < 0.001). Median time‐to‐first‐chemotherapy was 6.7 weeks and did not differ between centers. Patients with a higher tumor stage, younger age, and diagnosed more recently were more likely to receive adjuvant treatment. The 5‐year overall survival was significantly prolonged in patients treated with adjuvant chemotherapy—23% versus 17%, log‐rank = 0.01. In Cox regression analysis, treatment with adjuvant chemotherapy significantly prolonged survival compared with treatment without adjuvant chemotherapy. The finding that elderly patients and patients with a low tumor stage are less likely to undergo treatment needs further attention, especially since adjuvant treatment is known to prolong survival in most of these patients.

Nonsurgical therapies for resected and unresected pancreatic cancer in Europe and USA in 2003–2014: a large international population‐based study

“…28 These variations are not very likely explainable by differences in patient or tumor characteristics, which were mostly comparable across countries. A nationwide Dutch investigation focusing on resected PaCs in 2008-2013 further reported great inter-center variations (26-74%).…”

“…The strongest increase was observed in the Netherlands, where reimbursement for gemcitabine was possible since November 2008, 28 with utilization rates increasing from 10 (2003-2005) to 56% (2012-2014) among resected patients. The strongest increase was observed in the Netherlands, where reimbursement for gemcitabine was possible since November 2008, 28 with utilization rates increasing from 10 (2003-2005) to 56% (2012-2014) among resected patients.…”

Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer

“…Adjuvant chemotherapy is the current standard of care after resection of pancreatic cancer, but this treatment is often not given, or not completed, owing to a prolonged complicated postoperative course, or the preference of the patient or doctor. Data from the Netherlands Cancer Registry revealed that only 54 per cent of all patients undergoing pancreatoduodenectomy received adjuvant chemotherapy, because of toxicity, age and other factors. In the present review, the toxicity reported most frequently consisted of adverse gastrointestinal and haematological events.…”

Adjuvant chemotherapy followed by concurrent chemoradiation is associated with improved survival for resected stage I‐II pancreatic cancer

“…From our logistic MVA results, patients with pathologic T3‐4N1 diseases and positive surgical margins were more likely to receive C + CRT. A prior study has also shown that patients with a higher disease burden were more likely to receive adjuvant therapies …”