Poorer Outcomes Observed for Elderly vs Younger Patients with Metastatic Pancreatic Cancer
CHICAGO―Elderly patients with metastatic pancreatic cancer have shorter overall survival (OS), are less likely to receive chemotherapy and, if treated, receive fewer agents compared to younger patients, a retrospective study concluded at the 2013 American Society of Clinical Oncology (ASCO) Annual Meeting.
“These differences cannot be explained solely by performance status (PS) or disease characteristics and warrant further study,” noted Namrata Vijayvergia, MD, of Fox Chase Cancer Center, Philadelphia, PA, and colleagues.
Noting elderly patients with pancreatic cancer are poorly represented in clinical trials—despite a median age at diagnosis of 72 years—Dr. Vijayvergia and colleagues compared patterns of care and outcomes of patients 65 years of age or younger (n=155; median age, 58 years) and older than 65 years of age (n=122; median age, 73.5 years) by retrospectively analyzing medical charts of 277 patients with pancreatic cancer treated at Fox Chase Cancer Center between 2000 and 2010.
The two age groups were compared with respect to gender, comorbidities, PS, tobacco/alcohol use, primary site, stage, histological grade, metastatic sites, treatment modalities, type and number of chemotherapeutic agents received, and OS following diagnosis.
“The groups were well balanced with respect to sex (majority male), PS (majority ≤ 1), stage (majority 3, 4), and primary site (majority head),” the investigators noted.
Cardiovascular disease was more prevalent among older patients (odds ratio [OR], 1.7; P=0.04).
Older patients were less likely to receive any chemotherapy compared with younger patients (78% vs. 92%; OR, 0.33; P<0.001) and, if treated, were less likely to receive more than one agent (34% vs. 53%; OR, 0.48; P=0.003).
Median OS was shorter in older patients than in younger patients (5 vs. 6 months, P=0.01) but longer with higher number of agents received (relative risk [RR], 0.57 for young; RR, 0.51 for older; both P<0.001).
Cardiovascular and renal disease negatively impacted OS only in younger patients; in addition, they found that among the younger patients, presence of lung metastases was associated with longer survival (10 vs. 6 months; P=0.004), while liver metastases were associated with decreased survival (5 vs. 8 months; P=0.016).
“Additional studies are warranted for defining the appropriate management of older patients with pancreatic cancer,” Dr. Vijayvergia concluded.