This study has several limitations. We cannot be certain that the codes for palliative care are used appropriately and consistently across institutions; palliative interventions, therefore, may be underestimated in this study, although there is consistency of the estimated prevalence with other studies. Although the NCDB offers detailed staging, therapeutic, and survival data on patients with pancreatic cancer, it does not offer information regarding the specific type of chemotherapy regimens given or the type of palliative surgeries performed. Therefore, analyses comparing types of these interventions cannot be performed. Additionally, these data are subject to bias due to their retrospective nature, and the choice between various palliative interventions may be influenced by the health state of the patient. For example, the survival benefit observed with palliative chemotherapy may be in part due to the selection of healthier patients who are deemed “fit” enough to undergo chemotherapy. Furthermore, the accuracy of the “palliative” designation is dependent upon the coding by trained data entry personnel, and may be subject to substantial inter-coder variability that cannot be quantified. While any therapy in a patient with metastatic disease may be considered palliative, the lack of the palliative designation for all patients with Stage IV disease undergoing therapy indicates that the goals of therapy may not have been fully addressed with the patients during their healthcare encounters. Lastly, the database cannot discern individual patient and family preferences that may influence whether or not palliative care is pursued, and which approach is selected.
While the utilization of palliative therapies among patients with metastatic pancreatic cancer is increasing, deficiencies remain among a population that would likely benefit from these approaches. Moreover, there are areas of disparity—particularly among older patients and those with non-white race or ethnicity—that must be addressed on both a locoregional and national level. Since this disease is often symptomatic and can significantly impair functional status among patients who suffer from it, until medical and surgical therapies advance, the use of palliative therapies to improve quality of life among this population should remain a priority.
Conflicts of Interest: This project was presented in abstract form during a podium presentation at the European Society for Medical Oncology in Barcelona, Spain on June 29th, 2016.
Ethical Statement: This study was approved by the institutional review board of the Pennsylvania State University College of Medicine (STUDY00005949).
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Source: Journal of Gastrointestinal Oncology.
Accepted for publication May 04, 2017.