Real-world Impact of Availability of Adjuvant Therapy on Outcomes in Patients With Resected Pancreatic Adenocarcinoma

Abstract

Patients with resected pancreatic cancer (PC) have a poor prognosis. In 2004, European Study Group for Pancreatic Cancer 1 (ESPAC1) showed that the use of adjuvant therapy (AT) with 5-fluorouracil (5-FU) improves overall survival (OS). Subsequently, the British Columbia Cancer Agency (BCCA) introduced guidelines to offer AT as the standard of care for patients with resected PC. This study reviews the OS and disease-free survival (DFS) in a pre-AT era (2000 to 2004) to the AT era (2005 to 2008) at the BCCA. Using pathology records, all PC resections at Vancouver General Hospital from 2000 to 2008 were identified. Patients referred to the BCCA and their treatment records were obtained from the Cancer Agency Information System and BCCA pharmacy database. Charts were reviewed to abstract patient and tumor characteristics, DFS, and OS. Outcomes were compared by log-rank comparison. In the pre-AT era, 53 resections were recorded, with 64% referred to the BCCA. Median age was 65 years; poorly differentiated 59% and margin positive 38%. About 24% of patients received AT: all 5-FU. In the AT era, 64 resections were recorded, with 86% referred. Median age was 65 years, poorly differentiated 34% and margin positive 34%. 69% of patients received AT: 61% 5FU and 39% gemcitabine. Major reasons for no AT: delayed referral or metastases at time of referral 45% and poor performance status 35%. Pre-AT DFS 13 months versus 15 months AT era (P=0.55). Pre-AT OS 19 months versus 18 months AT era (P=0.59). Since the guideline for AT, there was an increase in the proportion of patients referred and treated, however, over 30% still do not receive or complete AT. In this single-institution series, there was no difference in survival outcomes between the pre-AT and AT eras. Strategies to improve rate and timeliness of referral should be explored.