Abstract
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Background: Cartright et al (2014) examined 2,422 patients in the iKnowMed database and found that patients with advanced pancreatic cancer lived longer with multi-agent chemotherapy compared to single-agent chemotherapy (11.2 months vs 7.2 months). Our goal was to compare survival of patients with stage IV pancreatic cancer receiving multi-agent, single-agent, or no chemotherapy using a significantly larger sample of patients identified in the National Cancer Database (NCDB). Methods: We identified 86,048 patients with stage IV pancreatic cancer. 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: Patients receivingmulti-agent chemotherapy were more likely to have private insurance than single-agent and no chemotherapy patients (49.9% vs. 33.0% vs. 22.9%, respectively), live in an area with a median income of $63,000+ (36.9% vs. 30.2% vs. 28.4%, respectively), receive treatment at an academic center (43.3% vs. 34.5% vs. 32.8%, respectively), and have no comorbidities (72.9% vs. 66.9% vs. 61.1%, respectively). Statistically significant survival differences were indicated between all chemotherapy groups (all adjusted p < 0.05), such that patients receiving multi-agent chemotherapy had the longest survival followed by patients receiving single-agent chemotherapy and patients receiving no chemotherapy (median survival = 7.4, 4.9, and 1.4 months, respectively). A larger proportion of patients receiving multi-agent chemotherapy were alive at 6, 12, and 24 months relative to patients receiving single-agent or no chemotherapy. Conclusions: Our study is the largest to show the benefit of multi-agent chemotherapy over single-agent chemotherapy for stage IV pancreatic cancer, as well as analyze the demographics of patients receiving differing chemotherapy treatments. [Table: see text]