Palliative and supportive care underutilization for patients with locally advanced pancreatic cancer: review of the NCDB

Background: Nearly one-third of patients with newly diagnosed pancreatic cancer present with locally advanced disease (LAPC), with 25% eligible for surgical resection, lending to a poor 5-year overall survival of 16.2%. Given the significant morbidity and mortality associated with LAPC, timely integration of palliative and supportive care (SC) into the treatment care plan is vital. The purpose of this study was to investigate the utilization of SC in patients with LAPC and identify the demographic and socioeconomic factors that influence its application. Patients and methods: A retrospective database analysis of the National Cancer Database (NCDB) was carried out. Data regarding patients diagnosed with stage II-III LAPC between 2004 and 2018 were used. Analyses included tumor characteristics, demographics, socioeconomic parameters, and trends in utilization of SC. Results: A total of 111 964 patients were included [stage II (72.3%); stage III (27.6%)]. Only 7.72% received SC despite 67% of patients receiving cancer-directed treatment at an academic or integrated network cancer program, 84% living in or near a metro area, and 60% living ≤20 miles of their primary treatment center. Rates of SC utilization remained <8% and <12% in stage II and III disease, respectively, throughout the two decades. Conclusions: SC has been underutilized in the LAPC population over the past two decades, despite the increase in data supporting early integration of palliative care and the potential sociodemographic areas of unmet need. Future work should focus on evaluating practice patterns across cancer centers and the potential positive impact of early SC integration on both survival and quality-of-life outcomes for patients with LAPC.