Abstract 4806
Background
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.
Methods
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.
Results
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.
Conclusions
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
| Characteristic | HR | 95% CI | p | |
|---|---|---|---|---|
| Tumor | Head/neck | 1 | .002 | |
| Body | 1.37 | 1.07 - 1.76 | .012 | |
| Tail | 1.51 | 1.19 - 1.90 | .001 | |
| Overlap or NOS | 1.32 | 1.07 - 1.65 | .012 | |
| Any chemo | .45 | .37 - .55 | < .001 | |
| Any referral | .54 | .45 - .67 | < .001 | |
| ECOG | 0 | 1 | < .001 | |
| 1 | 1.03 | .71 - 1.48 | .886 | |
| 2 | 1.76 | 1.20 - 2.58 | .004 | |
| 3 | 2.80 | 1.88 - 4.18 | < .001 | |
| 4 | 5.73 | 3.44 - 9.54 | < .001 | |
| ANC > 8 | 2.37 | 1.97 - 2.84 | < .001 | |
| Bilirubin | < ULN | 1 | < .008 | |
| 1 - 1.5x ULN | 1.35 | .99 - 1.83 | .057 | |
| > 1.5x ULN | 1.41 | 1.10 - 1.82 | .006 |
Clinical trial identification
Legal entity responsible for the study
Department of Oncology, Tom Baker Cancer Centre, University of Calgary.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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