Differences in patterns of care and outcomes of elderly versus younger metastatic pancreatic cancer (mPC) patients.

Abstract

9546 Background: Despite a median age at diagnosis of 72, elderly pancreatic cancer patients (pts) are poorly represented in clinical trials. We thus compared patterns of care and outcomes of mPC pts ≤ and > 65 yrs of age. Methods: We retrospectively analyzed medical charts of 277 mPC pts treated at an academic center between 2000 and 2009. Age groups ≤ 65 yrs and >65 yrs were compared with respect to gender, comorbidities, performance status (PS), tobacco/alcohol use, primary site, stage, histological grade, metastatic sites, treatment modalities, type and number of chemotherapeutic agents received, and survival after diagnosis of mPC (OS). Log-rank tests and Cox proportional hazards models were used to analyze survival endpoints and Fisher’s exact test to compare categorical variables. Results: 155 pts ≤65 yrs with median age of 58 and 122 pts >65 yrs with median age of 73.5 were evaluated. The groups were well balanced with respect to sex (majority male), PS (majority ≤1), stage (majority 3, 4), and primary site (majority head). Cardiovascular (CV) disease was more prevalent among older pts (OR 1.7, p=0.04). Older pts were less likely to receive any chemotherapy for mPC (79% vs 92%; OR 0.33, p< 0.001) and if treated were less likely to receive more than one agent (34% vs 52%; OR 0.48, p=0.003). Median OS was shorter in older pts (5m vs 6m, p=0.01). OS was longer with higher number of agents received (RR: 0.57 for young, 0.51 for old; p< 0.001). CV and renal disease negatively impacted OS only in younger pts. The presence of lung metastases was associated with longer survival (10m vs 6m (p=0.01)) and liver metastases with decreased survival (5m vs 8m (p<0.01)) only among younger pts. Conclusions: Elderly mPC pts have shorter OS, are less likely to receive chemotherapy, and if treated receive fewer agents compared to younger pts. These differences cannot be explained solely by PS or disease characteristics and warrant further study.