Burden Of Pancreatic Cancer Research Articles

Antimicrobial activity of chitosan coated silk fibroin micro-fibers

Changes in the burden of cancer mortality are expected to be observed among Spanish women. We predict those changes, in Spain, for breast cancer (BC), colorectal cancer (CRC), lung cancer (LC) and pancreatic cancer (PC) from 2013 to 2022.Bayesian age–period–cohort modeling was used to perform projections of the cancer burden in 2013–2022, extrapolating the trend of cancer mortality data from 1998 to 2012. We assessed the time trends of the crude rates (CRs) during 1998–2012, and compared the number of cancer deaths between the periods 2008–2012 and 2018–2022 to assess the contribution of demographic changes and changes in the risk factors for cancer.During 1998–2012, CRs of cancer decreased for BC (0.3% per year) and increased for LC (4.7%), PC (2%) and CRC (0.7%). During 2013–2022, CRs might level off for CRC, whereas the time trends for the remaining cancers might continue at a similar pace. During 2018–2022, BC could be surpassed by CRC as the most frequent cause of cancer mortality among Spanish women, whereas LC could be the most common cause of cancer mortality among women aged 50–69 years (N/year = 1960 for BC versus N/year = 1981 for LC). Comparing 2018–2022 and 1998–2012, changes in the risk factors for cancer could contribute 37.93% and 18.36% to the burden of LC and PC, respectively, and demographic shifts – mainly due to ageing (19.27%) – will drive the burden of CRC.During 2018–2022, demographic changes (ageing) and changes in risk factors could have a different impact on the lifetime risk of cancer among Spanish women.

Su1267 - The Burden of Pancreatic Cancer in the United States Population

Su1267 - The Burden of Pancreatic Cancer in the United States Population

PCN101 - Health Care Utilization and Economic Burden of Pancreatic Cancer in The Us Medicare Population

PCN101 - Health Care Utilization and Economic Burden of Pancreatic Cancer in The Us Medicare Population

Inpatient Burden of Pancreatic Cancer in the United States: An Analysis of National Trends in the United States From 1997 to 2012.

Inpatient Burden of Pancreatic Cancer in the United States: An Analysis of National Trends in the United States From 1997 to 2012.

Predictive global trends in the incidence and mortality of pancreatic cancer based on geographic location, socio-economic status, and demographic shift.

Pancreatic Cancer (PC) is a lethal malignancy that accounts for about 4% of cancer-related deaths worldwide. The aim of this study is to describe the influence of geography (based on WHO regions), socio-economic development (based on Human Development Index [HDI]) and demographic shift on the temporal trends in global incidence and mortality of PC. Data (2012-2030) relating to the incidence, mortality of PC and demographic shifts based on WHO regions and HDI areas were extracted from GLOBOCAN 2012. Linear regression was used to evaluate trends in total incidence and mortality. We noted a definite association between PC and higher socio-economic status. Advanced age (age ≥65) contributed to the rising burden in all socio-economic regions of the world except in the Low Human Development (LHD) countries where the disease predominantly affected population <65 years of age. The global burden of PC is expected to rise significantly over the next few decades regardless of geographic location, socio-economic development, age and gender. Advance knowledge of this data can help formulate strategies to specifically target countries and populations that promote public health policy to tackle this lethal disease on the global stage. J. Surg. Oncol. 2016;114:736-742. © 2016 Wiley Periodicals, Inc.

Contribution of changes in demography and in the risk factors to the predicted pattern of cancer mortality among Spanish women by 2022

BackgroundChanges in the burden of cancer mortality are expected to be observed among Spanish women. We predict those changes, in Spain, for breast cancer (BC), colorectal cancer (CRC), lung cancer (LC) and pancreatic cancer (PC) from 2013 to 2022. MethodsBayesian age–period–cohort modeling was used to perform projections of the cancer burden in 2013–2022, extrapolating the trend of cancer mortality data from 1998 to 2012. We assessed the time trends of the crude rates (CRs) during 1998–2012, and compared the number of cancer deaths between the periods 2008–2012 and 2018–2022 to assess the contribution of demographic changes and changes in the risk factors for cancer. ResultsDuring 1998–2012, CRs of cancer decreased for BC (0.3% per year) and increased for LC (4.7%), PC (2%) and CRC (0.7%). During 2013–2022, CRs might level off for CRC, whereas the time trends for the remaining cancers might continue at a similar pace. During 2018–2022, BC could be surpassed by CRC as the most frequent cause of cancer mortality among Spanish women, whereas LC could be the most common cause of cancer mortality among women aged 50–69 years (N/year=1960 for BC versus N/year=1981 for LC). Comparing 2018–2022 and 1998–2012, changes in the risk factors for cancer could contribute 37.93% and 18.36% to the burden of LC and PC, respectively, and demographic shifts – mainly due to ageing (19.27%) – will drive the burden of CRC. ConclusionsDuring 2018–2022, demographic changes (ageing) and changes in risk factors could have a different impact on the lifetime risk of cancer among Spanish women.

A Systematic Review of the Burden of Pancreatic Cancer in Europe: Real-World Impact on Survival, Quality of Life and Costs.

PurposeThe purpose of this study was to assess the overall burden of pancreatic cancer in Europe, with a focus on survival time in a real-world setting, and the overall healthy life lost to the disease.MethodsReal-world data were retrieved from peer-reviewed, observational studies identified by an electronic search. We performed two de novo analyses: a proportional shortfall analysis to quantify the proportion of healthy life lost to pancreatic cancer and an estimation of the aggregate life-years lost annually in Europe.ResultsNinety-one studies were included. The median, age-standardised incidence of pancreatic cancer per 100,000 was 7.6 in men and 4.9 in women. Overall median survival from diagnosis was 4.6 months; median survival was 2.8–5.7 months in patients with metastatic disease. The proportional shortfall analysis showed that pancreatic cancer results in a 98 % loss of healthy life, with a life expectancy at diagnosis of 4.6 months compared to 15.1 years for an age-matched healthy population. Annually, 610,000–915,000 quality-adjusted life-years (QALYs) are lost to pancreatic cancer in Europe. Patients had significantly lower scores on validated health-related quality of life instruments versus population norms.ConclusionsTo the best of our knowledge, this is the first study to systematically review real-world overall survival and patient outcomes of pancreatic cancer patients in Europe outside the context of clinical trials. Our findings confirm the poor prognosis and short survival reported by national studies. Pancreatic cancer is a substantial burden in Europe, with nearly a million aggregate life-years lost annually and almost complete loss of healthy life in affected individuals.Electronic supplementary materialThe online version of this article (doi:10.1007/s12029-015-9724-1) contains supplementary material, which is available to authorized users.

PCN53 - Systematic Review of Epidemiology and Burden of Pancreatic Cancer

PCN53 - Systematic Review of Epidemiology and Burden of Pancreatic Cancer

Sa2056 Increasing Inpatient Burden of Pancreatic Cancer in the United States: An Analysis of National Trends in the United States

Sa2056 Increasing Inpatient Burden of Pancreatic Cancer in the United States: An Analysis of National Trends in the United States

Helicobacter pylori and pancreatic diseases.

A possible role for Helicobacter pylori (H. pylori) infection in pancreatic diseases remains controversial. H. pylori infection with antral predomination leading to an increase in pancreatic bicarbonate output and inducing ductal epithelial cell proliferation could contribute to the development of pancreatic cancer via complex interactions with the ABO genotype, dietary and smoking habits and N-nitrosamine exposure of the host. Although the individual study data available so far is inconsistent, several meta-analyses have reported an increased risk for pancreatic cancer among H. pylori seropositive individuals. It has been suggested that H. pylori causes autoimmune pancreatitis due to molecular mimicry between H. pylori α-carbonic anhydrase (α-CA) and human CA type II, and between H. pylori plasminogen-binding protein and human ubiquitin-protein ligase E3 component n-recognin 2, enzymes that are highly expressed in the pancreatic ductal and acinar cells, respectively. Future studies involving large numbers of cases are needed in order to examine the role of H. pylori in autoimmune pancreatitis more fully. Considering the worldwide pancreatic cancer burden, as well as the association between autoimmune pancreatitis and other autoimmune conditions, a complete elucidation of the role played by H. pylori in the genesis of such conditions could have a substantial impact on healthcare.

Pancreatic Cancer Incidence and Mortality Patterns in China, 2009

To estimate the incidence and mortality rates for pancreatic cancer in China. After checking and reviewing the cancer registry data in 2009 from 72 cancer registry centers, we divided cancer registry areas into urban and rural areas. Incidence/mortality rates, age-specific incidence/mortality rates, age- standardized incidence/mortality rates, proportions, and cumulative incidence/mortality rates for pancreatic cancer were calculated. The total number of newly diagnosed pancreatic cancer cases and deaths in 2009 were 6,220 and 5,650, respectively. The crude incidence rate in all cancer registry areas was 7.28/100,000 (males 8.24, females 6.29). The age-standardized incidence rate by Chinese standard population (ASR) was 3.35/100,000, with ranking at 7th among all cancers. Pancreatic cancer incidence rate was 8.19/100,000 in urban areas whereas it was 5.41/100 000 in rural areas. Cancer mortality rate in all cancer registry areas was 6.61/100,000 (males 7.45; females 5.75), with ranking at 6th among all cancers, and 7.42/100 000 in urban but 4.94/100000 in rural areas. Pancreatic cancer incidence and mortality rates have shown a gradual increase in China. Owing to the difficulty of early diagnosis, identification of high-risk population and modification of risk factors are important to reduce the burden of pancreatic cancer.

National trends in pancreatic cancer outcomes and pattern of care among Medicare beneficiaries, 2000 through 2010

Pancreatic cancer is a major cause of morbidity and mortality in the Medicare population. Whether the health care burden of pancreatic cancer has changed over the last decade is unknown. The authors used Medicare data from 2000 to 2010 to identify beneficiaries aged ≥ 65 years who were hospitalized for the management of pancreatic cancer. Annual trends were estimated for the age-sex-race-adjusted initial hospitalization rate, the age-sex-race-comorbidity-adjusted 1-year mortality rate after initial hospitalization, age-sex-race-comorbidity-adjusted procedure rates, 1-year all-cause rehospitalizations after initial pancreatic cancer hospitalization, and mean inflation-adjusted Medicare payment for initial hospitalization. A total of 130,728 patients had ≥ 1 hospitalizations for pancreatic cancer and were identified from 56,642,071 beneficiaries during the study period. The age-sex-race-adjusted rate of initial hospitalization for pancreatic cancer was 50 per 100,000 person-years in 2010, representing a 0.5% annual increase since 2000 (95% confidence interval [95% CI], 0.3%-0.7%). In the same period, the age-sex-race-comorbidity-adjusted 1-year mortality rate decreased by 4.4% (95% CI, 3.9%-4.9%), and the age-sex-race-comorbidity-adjusted surgical resection rate increased by 6.9% (95% CI, 6.4%-7.5%). The mean inflation-adjusted Medicare payment for the initial hospitalization decreased, from $14,118 in 2000 to $13,318 in 2010, and the number of 1-year all-cause rehospitalizations after the initial hospitalization increased from 0.75 per patient in 2000 to 0.82 per patient in 2009 (all P < .001). For Medicare fee-for-service beneficiaries, initial pancreatic cancer hospitalization, surgical resection, and rehospitalization rates increased, but 1-year mortality rates declined over the last decade.

Irrelevance of microsatellite instability in the epidemiology of sporadic pancreatic ductal adenocarcinoma.

Background and AimsPancreatic cancer risk is increased in Lynch syndrome (LS) patients with mismatch repair gene defects predisposing to colonic and extracolonic cancers with microsatellite instability (MSI). However, the frequency of MSI pancreatic cancers has never been ascertained in consecutive, unselected clinical series, and their contribution to the sporadic and inherited burden of pancreatic cancer remains to be established. Aims of the study were to determine the prevalence of MSI in surgically resected pancreatic cancers in a multicentric, retrospective study, and to assess the occurrence of pancreatic cancer in LS.MethodsMS-status was screened by a panel of 5 mononucleotide repeats (Bat26, Bat25, NR-21, NR-24 and NR-27) in 338 consecutive pancreatic ductal adenocarcinoma (PDAC), resected at two Italian and one German referral centres. The personal history of pancreatic cancer was assessed in an independent set of 58 probands with LS and in 138 first degree relatives who had cancers.ResultsOnly one PDAC (0.3%) showed MSI. This was a medullary type cancer, with hMLH1-deficiency, and no identified germ-line mutation but methylation of hMLH1. Pancreatic cancer occurred in 5 (2.5%) LS patients. Histological sampling was available for 2 cases, revealing PDAC in one case and an ampullary cancer in the other one.ConclusionsMSI prevalence is negligible in sporadic, resected PDAC. Differently, the prevalence of pancreatic cancer is 2.5% in LS patients, and cancers other than PDAC may be encountered in this setting. Surveillance for pancreatic cancer should be advised in LS mutation carriers at referral centers.

Costs and trends in pancreatic cancer treatment

Pancreatic cancer poses a substantial morbidity and mortality burden in the United States, and predominantly affects older adults. The objective of this study was to estimate the direct medical costs of pancreatic cancer treatment in a population-based cohort of Medicare beneficiaries, and the contribution of different treatment modalities and health care services to the total cost of care and trends in costs over time. In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, pancreatic cancer patients were identified who were aged 66 years or older and who were diagnosed from 2000 to 2007. Total direct medical costs were estimated from Medicare payments overall and within categories of care. Costs attributable to pancreatic cancer were estimated by subtracting the costs of medical care in a matched cohort of cancer-free beneficiaries. A total of 15,037 patients were identified, of whom 97% were observed from diagnosis until death. Mean total direct medical costs were $65,500. Mean total costs were greater for patients with resectable locoregional disease ($134,700) than for those with unresectable locoregional or distant disease ($65,300 and $49,000, respectively). Hospitalizations and cancer-directed procedures collectively accounted for the largest fraction of health care costs. The total cost of care appeared to increase slightly over the study period (P = .05). The mean costs attributable to pancreatic cancer were $61,700. Despite poor prognosis and short survival, the economic burden of pancreatic cancer in the elderly is substantial. Demographic trends, greater use of targeted therapies, and possible implementation of screening strategies are likely to impact treatment patterns and costs in the future.

Epidemiology of pancreatic cancer: an overview

Pancreatic cancer, although infrequent, has an exceptionally high mortality rate, making it one of the four or five most common causes of cancer mortality in developed countries. The incidence of pancreatic cancer varies greatly across regions, which suggests roles for lifestyle factors, such as diet, or environmental factors, such as vitamin D exposure. Smoking is the most common known risk factor, and is the cause of 20-25% of all pancreatic tumors. Alcohol does not seem to be a risk factor, unless it leads to chronic pancreatitis, which is a probable risk factor. Long-standing diabetes increases the risk of pancreatic cancer, but can also be an early manifestation of pancreatic tumors. 5-10% of patients with pancreatic cancer have an underlying germline disorder, while the remaining percentage of cancer cases is thought to be caused by somatic mutations. Some individual studies suggest that mutations in various polymorphic genes can lead to small increases in the risk of pancreatic cancer, but these findings need to be replicated. Rising prevalence of smoking in developing countries, improved diagnosis and increasing population longevity are all likely to increase the global burden of pancreatic cancer in the coming decades.

Defining Determinants of Pancreatic Cancer Risk: Are We Making Progress?

Pancreatic cancer is the fourth leading cause of cancer-related mortality in the United States, and 80% – 85% of patients have incurable disease at the time of diagnosis. Furthermore, more than 95% of patients diagnosed with pancreatic cancer will ultimately die from the disease, highlighting the urgent need for novel insights into pancreatic tumorigenesis. Why has progress been so slow in defi ning predisposing factors for pancreatic cancer? First, its incidence rate is relatively low, when compared with other leading causes of cancer-related death, such as colorectal or breast cancer, so that fewer cases are available for study. Second, case – control studies have proved diffi cult. The rapid and nearly universal demise of patients with pancreatic cancer increases the susceptibility of retrospective studies to recall bias, selection bias, and exposure misclassifi cation, particularly when using proxy (ie, next of kin) respondents to collect eligibility and exposure data. In addition, studies in which plasma samples are collected at the time of diagnosis are diffi cult to interpret, due to the large alterations in patient nutritional and functional status caused by this malignancy. Third, although studies of families with high rates of pancreatic cancer have identifi ed several predisposing genetic variants, these variants are rare and contribute little to the overall population burden of pancreatic cancer. Fourth, no screening tests have been able to detect pancreatic cancer at an early, more treatable stage, leaving some to question whether risk factor identifi cation will impact patient outcomes, in the absence of a clear commitment to risk fac

Pancreatic Cancer in Canada: Incidence and Mortality Trends from 1992 to 2005

Pancreatic cancer is the fourth-ranking cause of death among all major malignancies in Canada and has the lowest five-year survival rate. To examine incidence and mortality trends of pancreatic cancer in Canada from 1992 to 2005, with particular emphasis on the role of cigarette smoking. Data from Health Canada and Statistics Canada were analyzed for age-adjusted incidence and mortality trends from 1992 to 2005. The future burden of pancreatic cancer in Canada was based on population projections. The incidence rate of pancreatic cancer for women between 1992 and 2005 remained stable (8.49 and 8.48 cases per 100,000, respectively), and there was a decrease in the incidence for men from 11.1 per 100,000 in 1992 to 9.89 per 100,000 in 2005. This reduction may be the result of a decrease in smoking rates among Canadian men. The mortality rate of this cancer remains high. Approximately 99% of all pancreatic cancer cases occur in individuals older than 50 years of age.The total number of annual cases of pancreatic cancer in Canada is expected to more than double from 2636 cases in 2006 to 5619 in the year 2031. The incidence of pancreatic cancer in Canada from 1992 to 2005 remained relatively stable, although the incidence decreased somewhat in men, perhaps as a result of a change in smoking behaviour. The total number of cases of pancreatic cancer is expected to more than double by 2031.

Burden of Pancreatic Cancer and Disease Progression: Economic Analysis in the US

Objectives: The few studies that have estimated the costs of pancreatic cancer were limited by small sample sizes, geography or patient age range. Using a large nationwide claims database, this study examines the cost of pancreatic cancer beginning with initial diagnosis and the additional costs when disease progresses. Methods: A retrospective cohort study was conducted using a claims database of 3 million individuals covered by large US employers. The study population consisted of patients newly diagnosed with pancreatic cancer in 1999–2000 and a demographically matched control group. Utilization and costs were summarized as monthly means. Changes in cancer severity and treatment over time were used to approximate disease progression and its associated costs. Results: The study included 412 pancreatic cancer patients and 1,236 controls. The mean follow-up time was 7.5 months. Regression-adjusted monthly costs attributable to pancreatic cancer were USD 7,279; over 60% resulted from hospitalizations. Patients with disease progression (over 50%) incurred an additional USD 15,143 per month compared to patients without disease progression. Conclusion: Compared to patients without cancer, the costs of pancreatic cancer patients were substantial, especially when patients experienced disease progression. New therapies that prevent or delay disease progression could potentially offset the costs to patients, providers and society.

Epidemiology and prevention of pancreatic cancer.

Pancreatic cancer is an uncommon tumor, but because the mortality rate approaches 100%, this form of cancer has now become a common cause of cancer mortality. In the United States it is the fourth most frequent cause of cancer mortality; in Japan it ranks as the fifth commonest cause of death from cancer. Smoking is the major known risk factor for pancreatic cancer, accounting for approximately 25-30% of all cases. Some of the time-dependent changes in the frequency of pancreatic cancer can be explained by smoking trends. Aggressive public health measures to control smoking would substantially reduce the burden of pancreatic cancer. Dietary factors are less important for pancreatic cancer than for other digestive tract tumors, but consumption of a diet with adequate quantities of fruits and vegetables, plus control of calories either by dietary measures or by exercise will help to prevent this lethal tumor. There are more than a dozen inherited germline mutations that increase the risk of pancreatic cancer. Of these, hereditary pancreatitis confers the greatest risk, while BRCA2 mutations are the commonest inherited disorder. In addition to germline defects, there are several common polymorphisms in genes that control detoxification of environmental carcinogens that may alter the risk of pancreatic cancer. More research will be needed in this area, to explain and to clarify the interaction between genes and environmental factors.

The epidemiology of pancreatic, gallbladder, and other biliary tract cancers

OVERVIEW Pancreatic cancer is the fifth leading cause of cancer-related death in the United States and will result in an estimated 29,700 deaths in 2002. In comparison, biliary tract cancer is rare, accounting for approximately 3500 deaths per year. The progression of pancreatic and biliary tract cancer often occurs without early symptoms, and diagnosis takes place late in the natural history of the disease. Consequently, both types of cancers have dismal survival rates, and treatment has little to no effect on prolonging the lives of these patients. The majority of pancreatic cancer arises in the exocrine pancreas. In the United States, incidence rates among men are approximately 1.3 times those among women, and blacks have 1.6 times the rates of whites. Incidence increases exponentially with age after 30 years old, and 80% of all cases are diagnosed between the ages of 60 and 80. Although pancreatic cancer incidence varies widely around the world, comparisons are challenging because of inconsistencies in diagnostic accuracy. However, industrialized nations appear to carry a higher burden of pancreatic cancer than less developed nations. In the past 2 decades, epidemiologic studies examining pancreatic cancer have been plagued with methodologic issues associated with studying a highly fatal disease, thereby hindering our understanding of the etiology of pancreatic cancer. Nevertheless, studies have consistently shown that tobacco smoking increases the risk of pancreatic cancer. Strong evidence also supports the association between pancreatic cancer and two medical conditions, chronic pancreatitis, and diabetes mellitus. Given that these conditions are often present numerous years before the cancer diagnosis, they should be considered as etiologically relevant. A series of recent studies indicate that obesity may be an important risk factor for pancreatic cancer. Other potential lifestyle risk factors include dietary factors such as carbohydrate and meat consumption, and physical activity. Biliary tract cancer can arise in the gallbladder or extrahepatic bile ducts. Gallbladder cancer is the most common of the two types and occurs more frequently in women than men. In contrast, extrahepatic bile duct cancer is seen more frequently in men. Although biliary tract tumors are relatively uncommon in the United States, certain ethnic groups, notably American Indians and Hispanic Americans, have substantially higher rates than the rest of the population. Gallstone disease is the most important risk factor for gallbladder cancer, increasing the risk by at least 3-fold. Because of the rarity of biliary tract tumors, diagnostic difficulties, and high mortality, other risk factors for this cancer are not well established. Among the potential risk factors are obesity, reproductive and hormonal factors, cholecystitis, biliary tract infections, and family history. Given the important epidemiologic dissimilarities of pancreaticobiliary cancers, correct classification is critical to improve the quality of epidemiologic studies. A better understanding of the underlying causes of these deadly cancers will provide new leads for early detection, treatment, and prevention. PANCREATIC CANCER Because the majority of pancreatic cancers occur in the exocrine pancreas, and tumors other than adenocarcinomas tumors are quite rare, this article will only focus on exocrine adenocarcinoma of the pancreas.