Deviations from Expected Treatment of Pancreatic Cancer in Octogenarians: Analysis of Patient and Surgeon Factors

Jonathan C. King, Mazen Zenati, Jennifer Steve, Sharon B. Winters, David L. Bartlett, Amer H. Zureikat, Herbert J. Zeh, Melissa E. Hogg

Research output: Contribution to journalArticle

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Abstract

Background: Morbidity and mortality of pancreatectomy has improved and chemotherapeutic options for pancreatic cancer (PC) are growing, yet there is reluctance to treat octogenarians. This study examined the reasons for failure to treat and analyzes outcomes in octogenarians with PC. Methods: Retrospective chart review 2005–2013. Demographics, tumor characteristics, treatment, reason for lack of treatment, Charlson comorbidity index (CCI), and survival were analyzed. Expected treatment for early-stage patients (I/II) included surgery ± chemotherapy ± radiation. Expected treatment for advanced stage patients (III/IV) was chemotherapy. Results: A total of 431 octogenarians were analyzed. Mean age was 84.0 ± 3.4, 59.6 % female, and 44.1 % received no treatment. Patients with operable tumors (I = 31 [7.2 %]/II = 214 [49.7 %]) had surgery 39.2 % of the time. Age was a predictor of not receiving surgery (odds ratio [OR] 0.78; 95 % confidence interval [CI] 0.70–0.86; p = 0.0001), whereas CCI was not. The most common reason for no surgery was contraindication despite similar CCI. Median overall survival for early-stage patients was better in the surgical group (15.8 vs. 5.5 months) than nonsurgical group (p < 0.0001). Advanced patients (III = 54 [12.5 %]/IV = 132 [30.6 %]) had similarly low treatment rates (n = 65 [34.9 %]). Survival for advanced disease was best for treated patients (6.9 vs. 1.8 months; p < 0.0001). CCI did not differ between those receiving chemotherapy and not, although age was significantly different (p < 0.0001). Conclusions: There is significant deviation from expected treatment for octogenarians with PC. While no correlation existed between CCI and treatment, age correlated with therapy for nearly all stages. Chronological age, not comorbidity, may drive recommendation for treatment in elderly patients.

Original languageEnglish (US)
Pages (from-to)4149-4155
Number of pages7
JournalAnnals of Surgical Oncology
Volume23
Issue number13
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Fingerprint

Pancreatic Neoplasms
Comorbidity
Therapeutics
Survival
Surgeons
Drug Therapy
Pancreatectomy
Neoplasms
Odds Ratio
Demography
Confidence Intervals
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

King, J. C., Zenati, M., Steve, J., Winters, S. B., Bartlett, D. L., Zureikat, A. H., ... Hogg, M. E. (2016). Deviations from Expected Treatment of Pancreatic Cancer in Octogenarians: Analysis of Patient and Surgeon Factors. Annals of Surgical Oncology, 23(13), 4149-4155. https://doi.org/10.1245/s10434-016-5456-0

Deviations from Expected Treatment of Pancreatic Cancer in Octogenarians : Analysis of Patient and Surgeon Factors. / King, Jonathan C.; Zenati, Mazen; Steve, Jennifer; Winters, Sharon B.; Bartlett, David L.; Zureikat, Amer H.; Zeh, Herbert J.; Hogg, Melissa E.

In: Annals of Surgical Oncology, Vol. 23, No. 13, 01.12.2016, p. 4149-4155.

Research output: Contribution to journalArticle

King, Jonathan C. ; Zenati, Mazen ; Steve, Jennifer ; Winters, Sharon B. ; Bartlett, David L. ; Zureikat, Amer H. ; Zeh, Herbert J. ; Hogg, Melissa E. / Deviations from Expected Treatment of Pancreatic Cancer in Octogenarians : Analysis of Patient and Surgeon Factors. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 13. pp. 4149-4155.
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abstract = "Background: Morbidity and mortality of pancreatectomy has improved and chemotherapeutic options for pancreatic cancer (PC) are growing, yet there is reluctance to treat octogenarians. This study examined the reasons for failure to treat and analyzes outcomes in octogenarians with PC. Methods: Retrospective chart review 2005–2013. Demographics, tumor characteristics, treatment, reason for lack of treatment, Charlson comorbidity index (CCI), and survival were analyzed. Expected treatment for early-stage patients (I/II) included surgery ± chemotherapy ± radiation. Expected treatment for advanced stage patients (III/IV) was chemotherapy. Results: A total of 431 octogenarians were analyzed. Mean age was 84.0 ± 3.4, 59.6 {\%} female, and 44.1 {\%} received no treatment. Patients with operable tumors (I = 31 [7.2 {\%}]/II = 214 [49.7 {\%}]) had surgery 39.2 {\%} of the time. Age was a predictor of not receiving surgery (odds ratio [OR] 0.78; 95 {\%} confidence interval [CI] 0.70–0.86; p = 0.0001), whereas CCI was not. The most common reason for no surgery was contraindication despite similar CCI. Median overall survival for early-stage patients was better in the surgical group (15.8 vs. 5.5 months) than nonsurgical group (p < 0.0001). Advanced patients (III = 54 [12.5 {\%}]/IV = 132 [30.6 {\%}]) had similarly low treatment rates (n = 65 [34.9 {\%}]). Survival for advanced disease was best for treated patients (6.9 vs. 1.8 months; p < 0.0001). CCI did not differ between those receiving chemotherapy and not, although age was significantly different (p < 0.0001). Conclusions: There is significant deviation from expected treatment for octogenarians with PC. While no correlation existed between CCI and treatment, age correlated with therapy for nearly all stages. Chronological age, not comorbidity, may drive recommendation for treatment in elderly patients.",
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AU - King, Jonathan C.

AU - Zenati, Mazen

AU - Steve, Jennifer

AU - Winters, Sharon B.

AU - Bartlett, David L.

AU - Zureikat, Amer H.

AU - Zeh, Herbert J.

AU - Hogg, Melissa E.

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N2 - Background: Morbidity and mortality of pancreatectomy has improved and chemotherapeutic options for pancreatic cancer (PC) are growing, yet there is reluctance to treat octogenarians. This study examined the reasons for failure to treat and analyzes outcomes in octogenarians with PC. Methods: Retrospective chart review 2005–2013. Demographics, tumor characteristics, treatment, reason for lack of treatment, Charlson comorbidity index (CCI), and survival were analyzed. Expected treatment for early-stage patients (I/II) included surgery ± chemotherapy ± radiation. Expected treatment for advanced stage patients (III/IV) was chemotherapy. Results: A total of 431 octogenarians were analyzed. Mean age was 84.0 ± 3.4, 59.6 % female, and 44.1 % received no treatment. Patients with operable tumors (I = 31 [7.2 %]/II = 214 [49.7 %]) had surgery 39.2 % of the time. Age was a predictor of not receiving surgery (odds ratio [OR] 0.78; 95 % confidence interval [CI] 0.70–0.86; p = 0.0001), whereas CCI was not. The most common reason for no surgery was contraindication despite similar CCI. Median overall survival for early-stage patients was better in the surgical group (15.8 vs. 5.5 months) than nonsurgical group (p < 0.0001). Advanced patients (III = 54 [12.5 %]/IV = 132 [30.6 %]) had similarly low treatment rates (n = 65 [34.9 %]). Survival for advanced disease was best for treated patients (6.9 vs. 1.8 months; p < 0.0001). CCI did not differ between those receiving chemotherapy and not, although age was significantly different (p < 0.0001). Conclusions: There is significant deviation from expected treatment for octogenarians with PC. While no correlation existed between CCI and treatment, age correlated with therapy for nearly all stages. Chronological age, not comorbidity, may drive recommendation for treatment in elderly patients.

AB - Background: Morbidity and mortality of pancreatectomy has improved and chemotherapeutic options for pancreatic cancer (PC) are growing, yet there is reluctance to treat octogenarians. This study examined the reasons for failure to treat and analyzes outcomes in octogenarians with PC. Methods: Retrospective chart review 2005–2013. Demographics, tumor characteristics, treatment, reason for lack of treatment, Charlson comorbidity index (CCI), and survival were analyzed. Expected treatment for early-stage patients (I/II) included surgery ± chemotherapy ± radiation. Expected treatment for advanced stage patients (III/IV) was chemotherapy. Results: A total of 431 octogenarians were analyzed. Mean age was 84.0 ± 3.4, 59.6 % female, and 44.1 % received no treatment. Patients with operable tumors (I = 31 [7.2 %]/II = 214 [49.7 %]) had surgery 39.2 % of the time. Age was a predictor of not receiving surgery (odds ratio [OR] 0.78; 95 % confidence interval [CI] 0.70–0.86; p = 0.0001), whereas CCI was not. The most common reason for no surgery was contraindication despite similar CCI. Median overall survival for early-stage patients was better in the surgical group (15.8 vs. 5.5 months) than nonsurgical group (p < 0.0001). Advanced patients (III = 54 [12.5 %]/IV = 132 [30.6 %]) had similarly low treatment rates (n = 65 [34.9 %]). Survival for advanced disease was best for treated patients (6.9 vs. 1.8 months; p < 0.0001). CCI did not differ between those receiving chemotherapy and not, although age was significantly different (p < 0.0001). Conclusions: There is significant deviation from expected treatment for octogenarians with PC. While no correlation existed between CCI and treatment, age correlated with therapy for nearly all stages. Chronological age, not comorbidity, may drive recommendation for treatment in elderly patients.

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