Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer

Francesca Dimou, Helmneh Sineshaw, Abhishek D. Parmar, Nina P. Tamirisa, Ahmedin Jemal, Taylor S. Riall

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Introduction: Pancreatic cancer is considered a systemic disease at presentation. Therefore, multimodality therapy with surgical resection and chemotherapy is the standard of care for locoregional disease. We described treatment patterns and time trends with regard to age and treatment center in the receipt of multimodality therapy. Methods: We used the National Cancer Data Base to identify patients ≥18 years old with stage I and II pancreatic adenocarcinoma. Treatment was defined as no treatment, resection only, chemotherapy only, or multimodality therapy, which consisted of both chemotherapy (neoadjuvant or adjuvant) and resection. Trends in the receipt and type of treatment were compared. Results: Of 39,441 patients, 22.8 % of patients received no treatment, 18.5 % received chemotherapy only, 23.0 % underwent surgical resection alone, and 35.8 % of patients received multimodality therapy. Receipt of multimodality therapy increased from 31.3 % in 2004 to 37.9 % in 2011 (p <0.0001). Patients >55 years were less likely to receive multimodality therapy (56–64 years: OR 0.83, 95 % CI 0.78–0.89; 65–75: OR 0.60, 95 % CI 0.55–0.65; ≥76: OR 0.17, 95 % CI 0.16–0.19 compared to patients 18–55). Compared to community hospitals, patients treated at an NCI-designated center were more likely to receive multimodality therapy (OR 1.62, 95 % CI 1.46–1.81) and, if they received multimodality therapy, delivery of chemotherapy in the neoadjuvant compared to adjuvant setting (OR 2.82, 95 % CI 2.00–3.98). Conclusion: Despite increased use of multimodality therapy, it remains underutilized in all patients and especially in older patients. Receipt of multimodality therapy and neoadjuvant therapy is highly dependent on treatment at NCI-designated cancer centers.

Original languageEnglish (US)
Pages (from-to)93-103
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Pancreatic Neoplasms
Therapeutics
Drug Therapy
Neoadjuvant Therapy
Community Hospital
Standard of Care

Keywords

  • Multimodality therapy
  • Pancreas
  • Pancreatic adenocarcinoma
  • Pancreatic cancer
  • Therapy
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Dimou, F., Sineshaw, H., Parmar, A. D., Tamirisa, N. P., Jemal, A., & Riall, T. S. (2016). Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer. Journal of Gastrointestinal Surgery, 20(1), 93-103. https://doi.org/10.1007/s11605-015-2952-7

Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer. / Dimou, Francesca; Sineshaw, Helmneh; Parmar, Abhishek D.; Tamirisa, Nina P.; Jemal, Ahmedin; Riall, Taylor S.

In: Journal of Gastrointestinal Surgery, Vol. 20, No. 1, 01.01.2016, p. 93-103.

Research output: Contribution to journalArticle

Dimou, F, Sineshaw, H, Parmar, AD, Tamirisa, NP, Jemal, A & Riall, TS 2016, 'Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer', Journal of Gastrointestinal Surgery, vol. 20, no. 1, pp. 93-103. https://doi.org/10.1007/s11605-015-2952-7
Dimou, Francesca ; Sineshaw, Helmneh ; Parmar, Abhishek D. ; Tamirisa, Nina P. ; Jemal, Ahmedin ; Riall, Taylor S. / Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer. In: Journal of Gastrointestinal Surgery. 2016 ; Vol. 20, No. 1. pp. 93-103.
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abstract = "Introduction: Pancreatic cancer is considered a systemic disease at presentation. Therefore, multimodality therapy with surgical resection and chemotherapy is the standard of care for locoregional disease. We described treatment patterns and time trends with regard to age and treatment center in the receipt of multimodality therapy. Methods: We used the National Cancer Data Base to identify patients ≥18 years old with stage I and II pancreatic adenocarcinoma. Treatment was defined as no treatment, resection only, chemotherapy only, or multimodality therapy, which consisted of both chemotherapy (neoadjuvant or adjuvant) and resection. Trends in the receipt and type of treatment were compared. Results: Of 39,441 patients, 22.8 {\%} of patients received no treatment, 18.5 {\%} received chemotherapy only, 23.0 {\%} underwent surgical resection alone, and 35.8 {\%} of patients received multimodality therapy. Receipt of multimodality therapy increased from 31.3 {\%} in 2004 to 37.9 {\%} in 2011 (p <0.0001). Patients >55 years were less likely to receive multimodality therapy (56–64 years: OR 0.83, 95 {\%} CI 0.78–0.89; 65–75: OR 0.60, 95 {\%} CI 0.55–0.65; ≥76: OR 0.17, 95 {\%} CI 0.16–0.19 compared to patients 18–55). Compared to community hospitals, patients treated at an NCI-designated center were more likely to receive multimodality therapy (OR 1.62, 95 {\%} CI 1.46–1.81) and, if they received multimodality therapy, delivery of chemotherapy in the neoadjuvant compared to adjuvant setting (OR 2.82, 95 {\%} CI 2.00–3.98). Conclusion: Despite increased use of multimodality therapy, it remains underutilized in all patients and especially in older patients. Receipt of multimodality therapy and neoadjuvant therapy is highly dependent on treatment at NCI-designated cancer centers.",
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