Progress for resectable pancreatic [corrected] cancer?: a population-based assessment of US practices.
BACKGROUND
: Pancreatic adenocarcinoma is a deadly disease; however, recent studies have suggested improved outcomes in patients with locoregional cancer. Progress was evaluated at a national level in resected patients, as measured by the proportion who received guideline-directed treatment and trends in survival.


METHODS
: The linked Surveillance, Epidemiology, and End Results and Medicare databases were queried to identify resections for pancreatic adenocarcinoma performed between 1991 and 2002. Receipt and timing of chemotherapy and radiation with respect to time-trend were assessed. Using logistic regression, factors associated with adjuvant combination chemoradiotherapy were identified. Kaplan-Meier curves stratified by year and treatment were used to assess survival.


RESULTS
: Of the 1910 patients, 47.9% (n = 915) received some form of adjuvant therapy within the first 6 months postoperatively; 34.4% (n = 658) received combination chemoradiotherapy (chemoRT). ChemoRT demonstrated a significant increase, from 29.2% to 37.5% (P < .0001). Neoadjuvant therapy was used in 5.7% (n = 108) of patients; no trend was observed during the study (P = .1275). The in-hospital mortality rate was 8.0% (n = 153 patients); no significant trend was noted (P = .3116). Kaplan-Meier survival, stratified by year group of diagnosis, did not change significantly over time (log-rank test, P = .4381), even with comparisons of the first 3 years with the last 3 years of the study (log-rank test, P = .3579).


CONCLUSIONS
: Adherence to guideline-directed care isimproving in the United States; however, the pace is slow, and overall survival has yet to be impacted significantly. Both increased use of adjuvant therapy and the development of more promising systemic treatments are necessary to improve survival for patients with resectable pancreatic cancer. Cancer 2010. (c) 2010 American Cancer Society.
Simons
Jessica P
JP
Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Ng
Sing Chau
SC
McDade
Theodore P
TP
Zhou
Zheng
Z
Earle
Craig C
CC
Tseng
Jennifer F
JF
D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D011159:Population Surveillance; D018714:Radiotherapy, Adjuvant; D018426:SEER Program; D014481:United States / Q000453:epidemiology