Pancreatic cancer in the USA: persistence of undertreatment and poor outcome.
OBJECTIVE
Despite decades of research, consensus on optimal treatment for pancreatic cancer has not been reached and survival remains bleak. This study aimed to evaluate predictors of treatment and survival among patients treated in community settings.


METHODS
A sample of pancreatic cancer patients who were diagnosed in 2009 and reported to the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program (n = 977) was included. Logistic regression was used to assess factors associated with therapy modality. Survival was examined using the Kaplan-Meier method and Cox proportional hazards regression. All analyses were conducted stratified by tumor stage.


RESULTS
Among stages I-II patients, 27 % received no treatment and only 47 % received surgery. Among these patients, no treatment was associated with older age, being a woman, not being married, lower income, and larger or unknown tumor size. Additionally, the type of adjuvant therapy received varied by tumor characteristics, race/ethnicity, and socioeconomic status. The most common therapies for stage III tumors were chemoradiation (40.8 %) and chemotherapy (21.9 %) alone. Half of stage IV patients received chemotherapy; chemotherapy was less common in patients who were older, in a minority race/ethnicity, and not married. Although treatment was associated with better prognosis, even among stages I-II patients who underwent surgery, a quarter succumbed to their disease within 17 months.


CONCLUSIONS
A significant proportion of pancreatic cancer patients remain undertreated primarily due to nonclinical factors, including marital status. Further investigating what aspects of marriage are contributing to this association will provide a better understanding of pancreatic cancer treatment barriers.
Applied Research Program, National Cancer Institute, 9609 Medical Center Drive, Room 3E506, Bethesda, MD, 20892-9762, USA, lindsey.enewold@nih.gov.
Lindsey
L
Enewold
Linda C
LC
Harlan
Thomas
T
Tucker
Shaun
S
McKenzie
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016016:Proportional Hazards Models; D018426:SEER Program; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology