Effect of age on delivering chemotherapy to older adults with advanced pancreatic adenocarcinoma.

Abstract

e13767 Background: Age is one of the most important risk factors for developing pancreatic adenocarcinoma (PDAC), 65% of the newly diagnosed cancer cases occur in individuals above 65 years of age (yo). The only potential cure for PDAC includes surgical resection, however, the majority of patients (70%) present with locally advanced/unresectable or metastatic PDAC (APDAC). Many oncologists remain hesitant to administer treatment to older adults for fear of perceived increased chemotoxicity risk and the thought of treatment intolerability. Methods: This retrospective cohort study included patients who were diagnosed and treated for APDAC within the Veterans Integrated Services Network (VISN) 8 which includes Veterans Affairs medical facilities in Florida, southern Georgia, Puerto Rico, and the U.S. Virgin Islands. Demographic data such as age, sex, race, ethnicity and treatment data such as chemotherapy and palliative care use were pulled from the VA Cancer Registry, available from Corporate Data Warehouse Data. We conducted a detailed chart review in the VA electronic health record to confirm stage and the eastern cooperative oncology group (ECOG) status at the time of diagnosis. Statistical analyses were conducted using GraphPad Prism 10.1.2 software. Analyses consisted of t-test for normally distributed continuous variables, chi-squared test for categorical variables and the Mann Whitney U test for the ECOG score of both groups. Results: Ninety-nine patients with APDAC above the of age 65 were identified from the period of June 1, 2017 till July 31, 2021. 46 received chemotherapy (C group) and 53 patients did not receive chemotherapy (NC group), characteristics (Table). The mean age for those in the C group were 72 years old (yo) vs 76 yo from the NC group with a P value of 0.0017 which was statistically significant. Looking at the age subgroups, the majority of the patients that received C, were of the 65-74 age subgroup (71%). The median ECOG for the NC group was 2 and that for C was 1 group. 39% of the C group received palliative care as opposed to 32% of the NC group with a P value of 0.532. Conclusions: Despite an acceptable ECOG range between 1 and 2, Age played an important factor in determining who received chemotherapy in APDAC. Studies other than ECOG are needed to help oncologists determine the fitness of APDAC patients and minimize hesitancy to deliver treatment. The involvement of palliative care in patients with APDAC was suboptimal and a push for more involvement of palliative care is needed. [Table: see text]