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.

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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).


1. Bernards N, Haj Mohammad N, Creemers GJ, et al. Ten weeks to live: a population-based study on treatment and survival of patients with metastatic pancreatic cancer in the south of the Netherlands. Acta Oncol 2015;54:403-10. [Crossref] [PubMed]

2. Conrad C, Lillemoe KD. Surgical palliation of pancreatic cancer. Cancer J 2012;18:577-83. [Crossref] [PubMed]

3. Poruk KE, Wolfgang CL. Palliative management of unresectable pancreas cancer. Surg Oncol Clin N Am 2016;25:327-37. [Crossref] [PubMed]

4. DiMagno EP. Pancreatic cancer: clinical presentation, pitfalls and early clues. Ann Oncol 1999;10:140-2. [Crossref] [PubMed]

5. Kuhlmann KF, de Castro SM, Wesseling JG, et al. Surgical treatment of pancreatic adenocarcinoma; actual survival and prognostic factors in 343 patients. Eur J Cancer 2004;40:549-58. [Crossref] [PubMed]

6. Obermeyer Z, Makar M, Abujaber S, et al. Association between the Medicare hospice benefit and health care utilization and costs for patients with poor-prognosis cancer. JAMA 2014;312:1888-96. [Crossref] [PubMed]

7. Wang JP, Wu CY, Hwang IH, et al. How different is the care of terminal pancreatic cancer patients in inpatient palliative care units and acute hospital wards? A nationwide population-based study. BMC Palliat Care 2016;15:1. [Crossref] [PubMed]

8. Werner J, Combs SE, Springfeld C, et al. Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol 2013;10:323-33. [Crossref] [PubMed]

9. Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997;15:2403-13. [Crossref] [PubMed]

10. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011;364:1817-25. [Crossref] [PubMed]

11. Kristensen A, Vagnildhaug OM, Gronberg BH, et al. Does chemotherapy improve health-related quality of life in advanced pancreatic cancer? A systematic review. Crit Rev Oncol Hematol 2016;99:286-98. [Crossref] [PubMed]

12. Gong J, Tuli R, Shinde A, et al. Meta-analyses of treatment standards for pancreatic cancer. Mol Clin Oncol 2016;4:315-25. [PubMed]

13. Stark A, Hines OJ. Endoscopic and operative palliation strategies for pancreatic ductal adenocarcinoma. Semin Oncol 2015;42:163-76. [Crossref] [PubMed]

14. Habermehl D, Brecht IC, Debus J, et al. Palliative radiation therapy in patients with metastasized pancreatic cancer – description of a rare patient group. Eur J Med Res 2014;19:24. [Crossref] [PubMed]

15. Rombouts SJ, Vogel JA, van Santvoort HC, et al. Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. Br J Surg 2015;102:182-93. [Crossref] [PubMed]

16. Johnson KS. Racial and ethnic disparities in palliative care. J Palliat Med 2013;16:1329-34. [Crossref] [PubMed]

17. Shavers VL, Harlan LC, Jackson M, et al. Racial/ethnic patterns of care for pancreatic cancer. J Palliat Med 2009;12:623-30. [Crossref] [PubMed]

18. Sharma RK, Cameron KA, Chmiel JS, et al. Racial/ethnic differences in inpatient palliative care consultation for patients with advanced cancer. J Clin Oncol 2015;33:3802-8. [Crossref] [PubMed]

Source: Journal of Gastrointestinal Oncology.
Accepted for publication May 04, 2017.