Initial treatment is associated with improved survival and end-of-life outcomes for patients with pancreatic cancer: a cohort study

We describe the association between initial treatment and end-of-life (EOL) outcomes among patients with pancreatic ductal adenocarcinoma (PDAC). This population-based cohort study included patients with PDAC who died from April 2010-December 2017 in Ontario, Canada using administrative databases. W...

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Bibliographic Details
Published in:BMC cancer 2022-12, Vol.22 (1), p.1312-9, Article 1312
Main Authors: Khan, Rishad, Salim, Misbah, Tanuseputro, Peter, Hsu, Amy T, Coburn, Natalie, Hallet, Julie, Talarico, Robert, James, Paul D
Format: Article
Language:English
Subjects:
Adenocarcinoma
Age
Ambulatory care
Arthritis
Cancer
Cancer therapies
Cardiovascular disease
Care and treatment
Chemotherapy
Codes
Cohort analysis
Cohort Studies
Comorbidity
Death
Diagnosis
Drug dosages
Emergency medical care
end-of-life care
Health care
Health insurance
Hospitalization
Humans
Intensive care
Medical research
Mortality
Ontario - epidemiology
Palliative Care
Pancreatic cancer
Pancreatic Neoplasms
Pancreatic Neoplasms - therapy
Patient outcomes
Patients
Population studies
population-based research
Population-based studies
Radiation
Radiation therapy
Radiotherapy
Regression analysis
Retrospective Studies
Services
Surgery
Survival
Terminal Care
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Summary:We describe the association between initial treatment and end-of-life (EOL) outcomes among patients with pancreatic ductal adenocarcinoma (PDAC). This population-based cohort study included patients with PDAC who died from April 2010-December 2017 in Ontario, Canada using administrative databases. We used multivariable models to explore the association between index cancer treatment (no cancer-directed therapy, radiation, chemotherapy, surgery alone, and surgery and chemotherapy), and primary (mortality, healthcare encounters and palliative care) and secondary outcomes (location of death, hospitalizations, and receipt of chemotherapy within the last 30 days of life). In our cohort (N = 9950), 56% received no cancer-directed therapy, 5% underwent radiation, 27% underwent chemotherapy, 7% underwent surgery alone, and 6% underwent surgery and chemotherapy. Compared to no cancer-directed therapy, radiation therapy (HR = 0.63), chemotherapy (HR = 0.43) surgery alone (HR = 0.32), and surgery and chemotherapy (HR = 0.23) were all associated with decreased mortality. Radiation (AMD = - 3.64), chemotherapy (AMD = -6.35), surgery alone (AMD = -6.91), and surgery and chemotherapy (AMD = -6.74) were all associated with fewer healthcare encounters per 30 days in the last 6 months of life. Chemotherapy (AMD = -1.57), surgery alone (AMD = -1.65), and surgery and chemotherapy (AMD = -1.67) were associated with fewer palliative care visits (all p-values for estimates above
ISSN:1471-2407
1471-2407
DOI:10.1186/s12885-022-10342-8