Retrospective Cohort Study of Palliative Care Patterns in Advanced Pancreatic Ductal Adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) survival remains poor over recent decades. Majority of patients present with incurable disease and emphasis is on improving quality of life. This study aims to characterise the service requirements and care patterns for palliative PDAC patients.

A retrospective cohort study of palliative patients with a histological diagnosis of PDAC, from 2014 to 2024 at North Shore Hospital, Auckland, was conducted. The cohort was stratified into three groups: locally advanced, metastatic and palliation due to comorbidities/personal choice despite resectability. Analyses included overall survival, interventions received, support service utilisation and inpatient requirements.

Three hundred thirteen patients diagnosed with PDAC were treated with palliative intent. Sixty-nine (22%) had locally advanced disease, 216 (69%) had metastatic disease and 28 (9%) were palliated due to comorbidities/patient choice. Median survival was shorter (p = 0.001) in the metastatic group (70 days; 95% CI, 55-85) compared to locally advanced disease (220 days; 95% CI, 153-286). Biliary interventions (59% vs. 38%, p = 0.001), utilisation of radiotherapy (12% vs. 4%, p = 0.03) and dietician input (36% vs. 25%, p = 0.03) were more common in the locally advanced group. Patients spent 92% of their time outside of hospital, but inpatient admissions increased from 14% to 53% in the final 3 months of life. 84% of deaths occurred outside hospital.

This study helped define the trajectory of palliative PDAC patients. Patients with locally advanced PDAC have distinctly different needs compared to those with metastatic disease, necessitating tailored approaches to intervention timing and end-of-life planning.