Survival by treatment recommendation and treatment receipt among older adults with localized pancreatic cancer.

BACKGROUND

Localized pancreatic cancer is generally treated with curative intent multidisciplinary care. However, the survival effect of treatment recommendations versus actual treatment receipt in older adults has not been well characterized. This study aimed to quantify survival differences by treatment recommendation and receipt among adults aged ≥65 years with localized pancreatic cancer.

METHODS

A population-based cohort study was conducted using data from 17 Surveillance, Epidemiology, and End Results registries including adults aged ≥65 years diagnosed with localized pancreatic cancer from 2000 to 2022. Treatment was categorized according to recommendation and receipt. Relative survival was estimated using the Ederer II method and cancer-specific mortality using Fine-Gray competing risk models.

RESULTS

Among 4409 patients (56.6% female, 73.3% non-Hispanic White), the 5-year relative survival was substantially higher for patients who underwent surgical resection (ages of 65-74 years: 25.6% [95% CI, 22.4-29.2]; ages of 75-84 years: 18.5% [95% CI, 15.3-22.3]) than for individuals without a surgery recommendation (2.0% [95% CI, 1.2-3.2]) or those recommended surgery but not treated (0.1% [95% CI, 0.0-1.3]). Compared with nonreceipt or refusal of therapy, receipt of surgery (adjusted hazard ratio [AHR], 0.26 [95% CI, 0.23-0.30]), radiotherapy (AHR, 0.82 [95% CI, 0.67-1.00]), and chemotherapy (AHR, 0.67 [95% CI, 0.63-0.72]) were associated with lower cancer-specific mortality. The risk of death after an early pancreatic cancer diagnosis was lower among males (AHR, 0.24 [95% CI, 0.20-0.29]) and was the lowest among non-Hispanic Asian/Pacific Islander patients (AHR, 0.21 [95% CI, 0.10-0.41]).

CONCLUSION

Receipt of recommended treatment-particularly surgical resection-was associated with improved survival and reduced cancer-specific mortality. The discordance between treatment recommendation and receipt relative to differences in sex and race/ethnicity highlight the need for equitable, individualized treatment decision-making beyond chronological age.