A Population-Based Study of Morbidity After Pancreatic Cancer Diagnosis

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Background: Pancreatic cancer is an aggressive disease characterized by early and relentless tumor spread, thus leading healthcare providers to consider it a “distant disease.” However, local pancreatic tumor progression can lead to substantial morbidity. This study defines the long-term morbidity from local and nonlocal disease progression in a large population-based cohort. Methods: A total of 21,500 Medicare beneficiaries diagnosed with pancreatic cancer in 2000 through 2011 were identified. Hospitalizations were attributed to complications of either local disease (eg, biliary disorder, upper gastrointestinal ulcer/bleed, pain, pancreas-related, radiation toxicity) or nonlocal/distant disease (eg, thromboembolic events, cytopenia, dehydration, nausea/vomiting/motility problem, malnutrition and cachexia, ascites, pathologic fracture, and chemotherapy-related toxicity). Competing risk analyses were used to identify predictors of hospitalization. Results: Of the total cohort, 9,347 patients (43.5%) were hospitalized for a local complication and 13,101 patients (60.9%) for a nonlocal complication. After adjusting for the competing risk of death, the 12-month cumulative incidence of hospitalization from local complications was highest in patients with unresectable disease (53.1%), followed by resectable (39.5%) and metastatic disease (33.7%) at diagnosis. For nonlocal complications, the 12-month cumulative incidence was highest in patients with metastatic disease (57.0%), followed by unresectable (56.8%) and resectable disease (42.8%) at diagnosis. Multivariable analysis demonstrated several predictors of hospitalization for local and nonlocal complications, including age, race/ethnicity, location of residence, disease stage, tumor size, and diagnosis year. Radiation and chemotherapy had minimal impact on the risk of hospitalization. Conclusions: Despite the widely known predilection of nonlocal/distant disease spread in pancreatic cancer, local tumor progression also leads to substantial morbidity and frequent hospitalization.

Submitted April 5, 2018; accepted for publication December 10, 2018.

Previous publication: This study was published as an abstract in J Clin Oncol 2018;36(Suppl 4):Abstract 236.

Author contributions: Study concept: Sarkar, Fero, Murphy. Data curation: All authors. Formal analysis: Sarkar, Fero, Seible, Panjwani, Murphy. Software: Sarkar, Fero, Matsuno, Murphy. Investigation: Sarkar, Fero, Seible, Murphy. Methodology: All authors. Validation: Sarkar, Fero, Panjwani, Murphy. Visualization: Sarkar, Fero, Matsuno. Supervision: Fero, Seible, Murphy. Resources: Murphy. Writing—original draft: Sarkar, Fero, Murphy. Writing—review and editing: Sarkar, Seible, Panjwani, Murphy.

Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: James D. Murphy, MD, MS, Department of Radiation Medicine and Applied Sciences, UC San Diego Moores Cancer Center, 3855 Health Sciences Drive, Suite 1414, La Jolla, CA 92093-0843. Email: j2murphy@ucsd.edu

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