Survival and cost associated with chemotherapy and chemoradiotherapy among resected pancreas cancer patients.

Abstract

351 Background: Pancreas cancer is expensive to treat, and the effectiveness of adjuvant chemotherapy (CT) and chemoradiation (CRT) following resection is debated. We compared both survival and healthcare costs by adjuvant therapy after curative-intent pancreaticoduodenectomy (PD) for pancreas adenocarcinoma (PC). Methods: All patients with resected PC in Ontario, Canada diagnosed 2004 to 2014 were identified and linked to administrative healthcare databases. Stratified Kaplan—Meier survival curves and log-rank test compared survival across treatment groups. Costs were assessed from the perspective of Ontario’s single-payer healthcare system and compared between CT and CRT. A one-year time horizon was used from the date of surgery. Results: 677 PC patients met all inclusion/exclusion criteria and underwent curative-intent PD with 77% receiving CT and 23% CRT. Median survival after resection was 21.7 and 18.9 months for CT and CRT groups, respectively. Patients receiving CRT were less likely to have high comorbidity burden (ADG ≥ 10), but were similar across other demographics. CRT patients were more likely to have margin positive disease. In a subgroup of 489 patients with margin negative disease, median survival in the node negative patients (n = 156) was 28.0 months for CRT and 24.7 months for CT (p = 0.8297, logrank). Median survival in the node positive patients (n = 333) was 20.6 months and 21.8 months for the CRT and CT patients, respectively (p = 0.9856, logrank). The median total one-year cost for CT was $52,575 (USD); CRT was $68,216 (Table 1). Conclusions: Patients who underwent adjuvant CT and CRT after PD for PC had similar overall survival, but healthcare expenditures were significantly higher in the CRT group. [Table: see text]