title: Ten weeks to live: a population-based study on treatment and survival of patients with metastatic pancreatic cancer in the south of the Netherlands.
abstract: BACKGROUND
  A large proportion of patients with pancreatic cancer presents with metastatic disease. We conducted a population-based study to evaluate trends in treatment and survival of patients with metastatic pancreatic cancer.
  
  
  METHODS
  We included all patients diagnosed with pancreatic cancer between 1993 and 2010 in the South of the Netherlands (N=3099). Multivariable logistic regression analysis was conducted to evaluate trends in treatment with chemotherapy. Crude overall survival according to period of diagnosis was analyzed, and independent risk factors for death were identified.
  
  
  RESULTS
  Forty-eight percent of the patients (N=1494) were diagnosed with metastatic disease. The percentage of patients being diagnosed with metastatic disease increased during the study period from 35% in 1993-1996 to 59% in 2009-2010 (p<0.0001). Overall, 18% of these patients received chemotherapy. The prescription of palliative chemotherapy almost tripled from 10% to 27% (p<0.0001). Treatment largely depended on age, ranging from 38% among patients aged <50 years [compared to 60-69 years: adjusted odds ratio (ORadj) 2.5 (95% CI 1.4-4.2)] to 1% among patients aged ≥80 years [compared to 60-69 years: ORadj 0.04 (95% CI 0.0-0.2)]. Patients were more likely to receive chemotherapy if they had a high socioeconomic status [ORadj 2.0 (95% CI 1.3-3.1)], and if diagnosis was pathologically verified [no verification vs. verification: ORadj 0.3 (95% CI 0.2-0.5)]. The administration of chemotherapy varied widely between 10 hospitals (5-34%, p<0.0001). The median overall survival of patients with metastatic pancreatic cancer remained 9-11 weeks.
  
  
  CONCLUSIONS
  A growing proportion of pancreatic cancer patients presented with metastatic disease. Usage of palliative chemotherapy increased over time, but median survival remained 9-11 weeks. In the near future, it should be evaluated if the recently introduced regimens have an impact on population-based survival.
authors.affiliation: Netherlands Cancer Registry, Comprehensive Cancer Center Netherlands , Eindhoven , The Netherlands.
authors.forename: Nienke
authors.initials: N
authors.lastname: Bernards
authors.forename: Nadia
authors.initials: N
authors.lastname: Haj Mohammad
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Creemers
authors.forename: Ignace H J T
authors.initials: IH
authors.lastname: de Hingh
authors.forename: Hanneke W M
authors.initials: HW
authors.lastname: van Laarhoven
authors.forename: Valery E P P
authors.initials: VE
authors.lastname: Lemmens
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D010529:Peritoneal Cavity; D010534:Peritoneal Neoplasms / Q000556:secondary; D012042:Registries; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents