Assessing the appropriateness of anticancer drugs for advanced pancreatic cancer: A retrospective analysis in three Spanish hospitals

Background The appropriateness of anticancer drug (ACD) therapy in advanced pancreatic cancer (PC) remains unclear. This study evaluated ACD use in patients with advanced PC across participating hospitals. Methods We conducted a retrospective, multicenter cohort study in three Spanish hospitals including all patients diagnosed with advanced PC between July 2014 and June 2016, with a 5-year follow-up period. We described patients’ characteristics and measured survival according to clinical stage diagnosis and the number of ACD treatment courses received. We assessed the appropriateness of treatments by estimating the proportion of ACD overuse, underuse of palliative care, and patient management. Results We included 133 patients (41.4% female, 81.2% stage IV, median age 72 years). Overall, 67.7% of patients received ACDs, of which 45.5% received two or more treatment courses. Median overall survival was four months (IQR 1-10 months), with higher survival time for stage III patients, more than two ACD treatments, and ECOG ≤2. As for inappropriateness of care, we found a potential overuse of ACD near death (20.3% received ACD in the last 30 days of life), and a potential underuse (11.3%) or late access (34.6%) to palliative care. Conclusions Our study found that survival in advanced PCs is very short and influenced by disease stage, ECOG performance status, and ACD treatment. Our study found that many patients potentially received excessive ACD near the end of life, while palliative care was often underused or delayed. More balanced evidence-based decisions are needed when facing therapeutic options for pancreatic cancer patients with poor prognosis, as well as their direct involvement once they are well-informed.