In search of lost time: delays in adjuvant therapy for pancreatic adenocarcinoma

Abstract

Presenter: Ahmad Hamad MD | The Ohio State University Background: Receipt of adjuvant chemotherapy for pancreatic adenocarcinoma (PDAC) within 12 weeks after surgery has an associated survival benefit and is recommended by the NCCN. This study seeks to identify patient and hospital factors associated with delays in initiation of adjuvant chemotherapy among patients with PDAC. Methods: Patients with non-metastatic PDAC who received a resection with curative intent followed by adjuvant chemotherapy between 2004 and 2017 were queried from the National Cancer Data Base. Patients who died within 30 or 90 days of surgery and patients who did not receive any chemotherapy were excluded. Descriptive statistics and multivariate models were constructed to determine the relationship between socioeconomic and clinical variables and delays in chemotherapy beyond 12 weeks from surgery. Results: A total of 25,891 patients with stage 1 (n=10,797, 41.7%), stage 2 (n=13,515, 52.2%), and stage 3 (n=1,579, 6.1%) disease were identified. Receipt of adjuvant chemotherapy within 12 weeks varied by stage (stage 1: 67.9% vs. stage 2: 75.7% vs. stage 3: 88.7%; p<0.001). Other univariate analyses shown in Figure. The median time to receipt of adjuvant chemotherapy was 60 days (IQR 35-85). Older age (OR 1.02, 95% CI 1.02-1.03; p<0.001), Non-Hispanic Black race (OR 1.23, 95% CI 1.11-1.36; ref Non-Hispanic White), Hispanic Black (OR 1.79, 95%CI 1.20-2.69; ref Non-Hispanic White), increasing comorbidity burden (OR 1.13, 95% CI 1.09-1.18) and being readmitted within 30 days of surgery (OR 1.51, 95%CI 1.36-1.66; p<0.001) were independently associated with delayed adjuvant chemotherapy. Conversely, higher neighborhood education level (no high school degree quartile < 6.3%: OR 0.77, 95% CI 0.70-0.85; ref: ≥17.6%), private insurance (OR 0.62, 95% CI 0.50-0.76, ref: uninsured), and living in rural-adjacent locations (OR 0.73 95% CI 0.61-0.86, ref: rural) were associated with receipt of timely adjuvant chemotherapy. Facility type, distance travelled, and hospital volume were not independent predictors of timely treatment. Patients who started chemotherapy more than 12 weeks after surgery had a 5% higher risk of death (HR 1.05, 95%CI 1.01-1.09; p=0.007). Conclusion: Receipt of adjuvant chemotherapy within 12 weeks for PDAC is associated with improved survival but is only achieved in 73.2% of patients. Age, race, comorbidities, education, and insurance are barriers to receiving timely adjuvant chemotherapy. Further studies are needed to evaluate interventions to address these disparities in treatment.