The Management of Older Adults with Pancreatic Adenocarcinoma.
John R OgdenHao XieWen Wee MaJoleen M HubbardPublished in: Geriatrics (Basel, Switzerland) (2018)
Pancreatic cancer is the eleventh most common cancer, yet it is the third leading cause of mortality. It is also largely a disease of older adults, with the median age of 71 at diagnosis in the US, with <1% of diagnoses occurring prior to age 50. Current NCCN guidelines recommend surgery for localized disease, followed by adjuvant therapy and/or consideration of enrollment in a clinical trial. For metastatic disease, current guidelines recommend clinical trial enrollment or systemic chemotherapy based on results from the landmark ACCORD-11 and MPACT trials. However, these trials focused heavily on younger, more fit patients, with the ACCORD-11 trial excluding patients over age 75 and the MPACT trial having 92% of its patients with a Karnofsky performance score >80. This article summarizes the available evidence in current literature in regards to the best treatment options for older adults, who represent the majority of pancreatic cancer diagnoses.
Keyphrases
- clinical trial
- phase ii
- study protocol
- phase iii
- physical activity
- end stage renal disease
- newly diagnosed
- open label
- systematic review
- squamous cell carcinoma
- ejection fraction
- minimally invasive
- small cell lung cancer
- health insurance
- double blind
- chronic kidney disease
- healthcare
- type diabetes
- papillary thyroid
- coronary artery disease
- radiation therapy
- cardiovascular disease
- prognostic factors
- acute coronary syndrome
- peritoneal dialysis
- risk factors
- locally advanced
- middle aged
- percutaneous coronary intervention
- drug induced