Treatment patterns and outcomes in pancreatic cancer: Retrospective claims analysis

Abstract

BackgroundPancreatic cancer represents the third leading cause of US cancer deaths, with median survival <1 year. The goal of this study was to describe systemic treatments, healthcare utilization and costs, and overall survival among patients with unresectable/metastatic disease.MethodsThis study used healthcare claims for commercial and Medicare Advantage enrollees diagnosed with pancreatic adenocarcinoma (at index date) during January 01 2010 to 31 May 2017. Included patients were aged ≥18 years, with continuous 6‐month preindex enrollment. Patients were excluded by resectable disease, another primary cancer, or pregnancy. Cohorts were based on first‐line (LOT1) chemotherapy regimen.ResultsOverall, 12 978 patients (mean age 70 years, 51% male) were included, among which 5610 (43%) received chemotherapy. Of those, 23% received gemcitabine monotherapy, 22% gemcitabine‐nab paclitaxel, 22% FOLFIRINOX, 3% FOLFOX, and 29% received other regimens. Mean LOT1 duration was 112 days; 60% did not undergo subsequent lines of therapy. Moreover, 50% of patients had an emergency room visit and 45% were hospitalized during LOT1. Among treated and untreated patients, mean total 6‐month costs were $52 101. We found that patients receiving FOLFIRINOX had the highest costs, whereas those who received gemcitabine monotherapy had the lowest. Median overall survival (mOS) was 335 days with any first‐line treatment. FOLFIRINOX‐treated patients had the highest mOS (492 days), whereas gemcitabine monotherapy‐treated patients had the lowest (223 days).ConclusionsA large proportion (57%) of patients with unresectable/metastatic pancreatic cancer did not receive chemotherapy. Healthcare costs were higher for fluorouracil‐based regimens, while lower for gemcitabine‐based regimens. Survival rates were within expectations for advanced pancreatic cancer.

Sex, Gender and Age Differences in Treatment Allocation and Survival of Patients With Metastatic Pancreatic Cancer: A Nationwide Study

“…These factors and their impact on treatment decisions need further investigation. Although the findings in our study on the percentage of patients being treated with systemic treatment and pancreatic cancer diagnosis being more common in men than in women are in line with other European and American studies ( 46 , 47 ), it might be difficult to generalize our findings to the rest of the (Western) world because ethnic differences may have an impact. Information on ethnicity is not captured in our study because this was not registered in the NCR.…”

Reducing nihilism in metastatic pancreatic ductal adenocarcinoma: Treatment, sequencing, and effects on survival outcomes

“…The proportion of patients with PDAC receiving systemic chemotherapy in the metastatic setting (74.2%) in the present analysis is higher than those reported from patient databases in previous studies for stage IV pancreatic cancer 18,20 and noncurative PDAC. 17 In total, 140,210 patients with stage IV pancreatic cancer were included in the National Cancer Data Base from 2000 to 2011; the proportion receiving systemic treatment increased from 47% to 52% during the study.…”

“…Abbreviations: CI, confidence interval Advantage enrollees diagnosed with PDAC between January 2011 and May 2017 only 43% of patients received chemotherapy. 20 No trends over time were reported. Comparing these studies with the current analysis suggests that a general increase in cancer-directed therapy has occurred recently.…”

“…Of 10,881 patients in the Ontario Cancer Registry who received a new diagnosis of noncurative PDAC between 2005 and 2016, 38.1% received cancer‐directed therapy (including chemotherapy [26.6%] and chemoradiation therapy [11.5%]) 17 . Among 12, 978 Medicare Advantage enrollees diagnosed with PDAC between January 2011 and May 2017 only 43% of patients received chemotherapy 20 . No trends over time were reported.…”

Prognostic value of the Memorial Sloan Kettering Prognostic Score in metastatic pancreatic adenocarcinoma

“…Although our data are from 2011-2014, the outcomes with mature follow-up were consistent with present-day overall survival values observed in patients with mPDAC at diagnosis. [27][28][29][30] Our study has elucidated several clinical characteristics associated with overall survival; some corroborate or expand previously identified variables, and others are novel. Performance status was among the first clinical indicators of prognosis established in all cancer types, including pancreatic cancer.…”