Utilization of palliative care for geriatric veterans with newly diagnosed stage 3 and 4 pancreatic cancer.
Authors: Ekta Panjrolia, Toufic Tannous, Natasha M. Resendes, Raiyan Islam, Iriana M. Hammel
Journal: Journal of Clinical Oncology (2024)

e24082 Background: Locally advanced and metastatic pancreatic cancer continues to be difficult to treat with high mortality. For stage 3 and stage 4 pancreatic cancer, there remains no meaningful advances in treatment and standard of care heavily relies on a palliative approach. Yet, there remains reports that early use of palliative care (PC) may be underutilized despite palliative care being mainstay of treatment. We sought to further characterize which factors may play a role in PC referral within the geriatric veteran population. Methods: This retrospective cohort study included veterans who were diagnosed and treated for pancreatic cancer within the Veterans Integrated Services Network (VISN) 8 which includes Veterans Affairs medical facilities in Florida, southern Georgia, Puerto Rico and the U.S. Virgin Islands. Demographic data such as age, sex, race, ethnicity and branch of service and treatment data such as chemotherapy and PC use were pulled from the electronic medical record. We conducted a chart review to determine stage and ECOG status at the time of diagnosis. Of this cohort, 99 veterans were identified who met the criteria of 65 years of age or older at the time of newly diagnosed stage 3 or stage 4 pancreatic cancer. Statistical analyses were conducted using GraphPad Prism 10.1.2 software and analyses consisted of t-test, Mann-Whitney, chi-squared, multiple regression model and odds ratio. Results: The mean age for veterans who did not receive PC was 74.66 years and veterans who did receive PC mean age was 74.79, revealing no statistically significant difference (p = 0.9205). The median ECOG for veterans who did and did not receive PC was 1 (p = 0.6609). Chemotherapy use in the PC and no PC groups did not differ with about 49% of veterans in the no PC group receiving chemotherapy and 42% of veterans received PC and chemotherapy (p = 0.5329). Furthermore, sex, race, ethnicity, stage 3 vs 4, and branch of military service were not found to be statistically significant between the PC and no PC groups. We found no statistically significant relationship between frequency of PC utilization (p = 0.4450) with age (OR = 1.001; 95% CI 0.9331-1.072), ECOG score (OR = 1.059; 95% CI 0.7425 – 1.504) or chemotherapy use (OR = 0.7353; 95% CI 0.2936 – 1.821). The OR for age, ECOG and chemotherapy use all cross 1.0 demonstrating that these independent variables do not have a correlation with PC utilization. Conclusions: Between geriatric veterans with newly diagnosed stage 3 and stage 4 pancreatic cancer who did and did not receive PC, there appears to be no statistically significant difference in ECOG status, age, ethnicity, use of chemotherapy or branch of military service. Our data demonstrates that otherwise prognostic features such as age and ECOG did not differ in veterans who did and not receive PC regardless of chemotherapy use, however overall more PC referrals are still needed within this patient population.