title: Patterns of care and outcomes of older versus younger patients with metastatic pancreatic cancer: A Fox Chase Cancer Center experience.
abstract: BACKGROUND
  Older patients with metastatic pancreatic cancer (mPC) are poorly represented in clinical trials. We compared patterns of care and outcomes of patients with mPC < and >65 yrs (Group 1 and Group 2, respectively) treated at Fox Chase Cancer Center (FCCC) to identify predictors of survival and better understand the treatment approaches.
  
  
  METHODS
  Charts of 579 patients with mPC treated at FCCC from 2000 to 2010 were reviewed. Group 1 and Group 2 were compared with respect to baseline, treatment characteristics, and overall survival (OS) after diagnosis of metastatic disease.
  
  
  RESULTS
  299 patients in Group 1 (median age 57) and 280 patients in Group 2 (median age 73) were evaluated. Patients in Group 2 were less likely to receive any chemotherapy for mPC compared to Group 1 (65% vs 75%, p=0.001) and if treated were less likely to receive more than one agent (37% vs 53%, p<0.001). Survival was comparable between the two groups (p=0.16) and Charlson Co-morbidity Index did not emerge as a prognostic factor. Longer OS was associated with higher number of agents used in both groups (p<0.001). Liver metastases conferred worse survival (p=0.02) while lung metastases conferred better survival in both groups (p=0.002).
  
  
  CONCLUSIONS
  Older mPC patients are less likely to receive chemotherapy and receive fewer agents yet have similar OS compared to younger patients. OS improves with increasing number of agents, supporting the use of combination chemotherapy in healthy older patients. Our findings encourage enrollment of older patients with mPC with good performance status onto clinical trials with stratification by site of metastases.
authors: Deparment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. Electronic address: namrata.vijayvergia@fccc.edu.
authors: Namrata
authors: N
authors: Vijayvergia
authors: Deparment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors: Efrat
authors: E
authors: Dotan
authors: Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors: Karthik
authors: K
authors: Devarajan
authors: Department of General Internal Medicine, Temple University Hospital, Philadelphia, PA, USA.
authors: Kamel
authors: K
authors: Hatahet
authors: Deparment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors: Farah
authors: F
authors: Rahman
authors: Deparment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors: Julianna
authors: J
authors: Ricco
authors: Deparment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors: Bianca
authors: B
authors: Lewis
authors: Bryn Mawr Medical Associates, Bryn Mawr, PA, USA.
authors: Sameer
authors: S
authors: Gupta
authors: Deparment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors: Steven J
authors: SJ
authors: Cohen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary*; D008175:Lung Neoplasms / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Chemotherapy; Metastatic pancreatic cancer; Older adults