Referral patterns and predictors of survival for Stage IV pancreatic ductal adenocarcinoma

Date 22 October 2018
Event ESMO 2018 Congress
Session Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Topics Pancreatic Cancer
Presenter Aleksi Suo
Citation Annals of Oncology (2018) 29 (suppl_8): viii562-viii575. 10.1093/annonc/mdy297
Authors A.E. Suo, P.A. Tang, D. Tilley, W.Y. Cheung, R. Lee-Ying
  • Medical Oncology, Tom Baker Cancer Centre, T2N 4N2 - Calgary/CA



We previously found that many patients with a diagnosis of advanced pancreatic ductal adenocarcinoma (PDAC) are not referred for palliative chemotherapy despite recent advances. We sought to investigate referral patterns, chemotherapy eligibility and predictors of overall survival (OS) in a large cohort of advanced PDAC in Alberta, Canada.


All patients with Stage IV PDAC from 2009 - 2015 in Alberta were identified using the Alberta Cancer Registry. Patients missing laboratory eligibility criteria for chemotherapy were excluded. Demographics, clinical characteristics, cancer centre referral, chemotherapy received, and OS were collected. Primary analysis explored referral patterns and treatment eligibility. Secondary outcomes identified predictors of survival using Kaplan-Meier with log-rank test and multivariable Cox regression analysis.


1412 patients were identified. ECOG (>1 = 83%; >2 = 72%), age (34%) and bilirubin (>ULN = 30%; >1.5xULN = 22%) were the most common reasons for chemotherapy ineligibility. A proportion of patients who were eligible by trial criteria for FOLFIRINOX (21%) and nab-paclitaxel/gemcitabine (20%) were not referred, yet some patients who were ineligible for any chemotherapy were still referred. Distance to travel to a cancer centre did not have a significant difference on referral patterns. Primary tumor location, any chemotherapy received, referral, ECOG, bilirubin, and ANC were significant predictors of survival in the Cox regression analysis.


More patients who are potentially eligible to receive palliative chemotherapy should be referred to a cancer centre. Patients with obstructive jaundice should have expedited biliary drainage procedures to facilitate systemic treatment eligibility.Table: 1598P

Cox regression analysis of predictors for overall survival

CharacteristicHR95% CIp
Body1.371.07 - 1.76.012
Tail1.511.19 - 1.90.001
Overlap or NOS1.321.07 - 1.65.012
Any chemo.45.37 - .55< .001
Any referral.54.45 - .67< .001
ECOG01< .001
11.03.71 - 1.48.886
21.761.20 - 2.58.004
32.801.88 - 4.18< .001
45.733.44 - 9.54< .001
ANC > 82.371.97 - 2.84< .001
Bilirubin< ULN1< .008
1 - 1.5x ULN1.35.99 - 1.83.057
> 1.5x ULN1.411.10 - 1.82.006

Clinical trial identification

Legal entity responsible for the study

Department of Oncology, Tom Baker Cancer Centre, University of Calgary.


Has not received any funding.

Editorial Acknowledgement


All authors have declared no conflicts of interest.