title: Adjuvant therapy for pancreas cancer in an era of value based cancer care.
abstract: In resected pancreas cancer, adjuvant therapy improves outcomes and is considered the standard of care for patients who recover sufficiently post operatively. Chemotherapy or combined chemotherapy and radiation therapy (chemoradiation; CRT) are strategies used in the adjuvant setting. However, there is a lack of evidence to suggest whether the addition of RT to chemotherapy translates to an improvement in clinical outcomes. This is true even when accounting for the subset of patients with a higher risk for recurrence, such as those with R1 and lymph node positive disease. When considering the direct and indirect costs, impact on quality of life and questionable added clinical benefit, the true "net health benefit" from added RT to chemotherapy becomes more uncertain. Future directions, including the utilization of modern RT, integration of novel therapies, and intensifying chemotherapy regimens may improve outcomes in resected pancreas cancer.
authors.affiliation: The Ohio State University Wexner Medical Center, 310 W. 10th Ave, Columbus, OH, United States.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Ahn
authors.affiliation: The Ohio State University Wexner Medical Center, 310 W. 10th Ave, Columbus, OH, United States.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Williams
authors.affiliation: Winship Cancer Institute, Emory University, 1365-C Clifton Rd NE, Atlanta, GA, United States.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Goldstein
authors.affiliation: Winship Cancer Institute, Emory University, 1365-C Clifton Rd NE, Atlanta, GA, United States.
authors.forename: Bassel
authors.initials: B
authors.lastname: El-Rayes
authors.affiliation: The Ohio State University Wexner Medical Center, 310 W. 10th Ave, Columbus, OH, United States. Electronic address: Tanios.saab@osumc.edu.
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
mesh_terms: D000230:Adenocarcinoma / Q000191:economics / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D019496:Cancer Vaccines / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000191:economics; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000191:economics; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005544:Forecasting; D006801:Humans; D007167:Immunotherapy; D008207:Lymphatic Metastasis; D058990:Molecular Targeted Therapy; D015337:Multicenter Studies as Topic; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000191:economics / Q000628:therapy*; D018579:Patient Selection; D057285:Precision Medicine; D011446:Prospective Studies; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D016896:Treatment Outcome; D062505:Value-Based Purchasing
chemical_list: D019496:Cancer Vaccines
keywords: Adjuvant therapy; Chemoradiation; Chemotherapy; Net health benefit; Pancreatic cancer