Trends in Preoperative Chemotherapy Utilization for Proximal Pancreatic Cancer: Are We Making Progress?

Area of Science:

• Oncology
• Surgical Oncology
• Health Services Research

Background:

• Neoadjuvant chemotherapy (NCT) is crucial for pancreatic cancer (PDAC) management before pancreaticoduodenectomy (PD).
• Current practice shows inconsistent NCT utilization and unclear reasons for its omission.
• This study examines national trends and determinants of NCT use in PDAC.

Purpose of the Study:

• To investigate national rates and trends in neoadjuvant chemotherapy utilization for pancreatic cancer patients undergoing pancreaticoduodenectomy.
• To identify factors influencing the adoption of neoadjuvant chemotherapy in pancreatic cancer treatment.
• To understand the impact of institutional and patient-related factors on chemotherapy sequencing.

Main Methods:

• Utilized the National Cancer Database to identify patients with PDAC who underwent PD between 2006 and 2017.
• Analyzed changes in chemotherapy sequencing over time.
• Employed multivariable logistic regression models to determine factors affecting NCT utilization for patients diagnosed after 2010.

Main Results:

• Out of 128,980 diagnosed patients, 23,206 underwent PD; 12.9% received NCT.
• Preoperative chemotherapy (NCT + PCT) utilization rose from 7.3% in 2004 to 36.8% in 2017.
• Factors influencing NCT included patient age, institution type (academic, integrated network), institutional volume, distance, cancer stage, grade, and insurance status.

Conclusions:

• NCT utilization is increasing, yet over 60% of patients do not receive preoperative chemotherapy, and nearly 20% receive none.
• Omission of NCT is linked to modifiable factors like institution type and healthcare disparities.
• Policy and reimbursement changes are needed to improve national practice patterns and optimize oncologic management for pancreatic cancer.