Abstract
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Background: Cancer incidence is higher in the elderly, yet these patients tend to be underrepresented in clinical trials and receive less treatment than their younger counterparts. This study seeks to elucidate the impact of chemotherapy in elderly patients with stage IV pancreatic cancer. Methods: We identified 68,044 patients with stage IV pancreatic cancer over the age of 65 diagnosed between the years 2004-2013. Between-chemotherapy survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p < .05 indicated statistical significance. Results: Statistically significant differences in demographics of patients with and without chemotherapy included that patients given chemotherapy were more likely to live in an area with a median income of $63,000+ (34.9% vs 30.2%, respectively), receive treatment at an academic center (36.6% vs. 30.7% respectively), and have no comorbidities (66.9% vs. 59.4%, respectively) compared to those not given chemotherapy. Statistically significant survival differences were indicated between all chemotherapy groups (all adjusted p < 0.05), such that patients receiving chemotherapy survived longer than those without chemotherapy (median survival 5.5, 1.3 months, respectively). A larger proportion of patients receiving chemotherapy were alive at 6, 12, and 24 months relative to patients receiving no chemotherapy. Use of chemotherapy has increased over time for elderly stage IV pancreatic cancer patients, such that 37.9% of patients diagnosed in 2004 received chemotherapy, while 45.9% of patients diagnosed in 2013 received chemotherapy. Conclusions: To our knowledge, we are the largest trial to investigate treatment of stage IV pancreatic cancer in the elderly. Although the prognosis is overall poor, chemotherapy provided a mild survival benefit. Use of chemotherapy in these patients increased from 2004 to 2013, yet less than half of patients received chemotherapy. [Table: see text]