Frailty and low utilization of curative-intent surgical resection in nonmetastatic pancreatic cancer.

Abstract

Background: Curative-intent treatment for pancreatic ductal adenocarcinoma necessitates major surgery and chemotherapy, yet many patients do not undergo resection. Frailty may contribute to this phenomenon, but its prevalence and association with pancreatectomy in pancreatic ductal adenocarcinoma remains poorly defined. This study describes the distribution of frailty and its association with curative-intent surgery in a nationally representative cohort of patients with nonmetastatic pancreatic ductal adenocarcinoma.

Methods: Using Surveillance, Epidemiology, and End Results-Medicare data (2013-2019), we identified patients aged 66 years and older with nonmetastatic pancreatic ductal adenocarcinoma. Frailty was categorized as nonfrail, prefrail, mildly frail, or moderately to severely frail using the claims-based frailty index over the 12 months preceding diagnosis. We evaluated frailty distributions via kernel density estimation. We assessed the association between frailty category and receipt of surgery via logistic regression.

Results: Among 8237 patients (mean age = 78 years, 57.6% female, 77.4% White race), 2486 (30.2%) underwent curative-intent pancreatectomy. Surgery was performed in 39.7% of nonfrail and 30.7% of prefrail patients; after adjustment, prefrail patients had similar odds of resection compared to nonfrail patients (adjusted odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.89 to 1.16). In contrast, 15.8% of mildly frail and 5.7% of moderately to severely frail patients underwent surgery; both groups had statistically significant lower odds of surgery vs nonfrail patients (mildly frail adjusted OR = 0.53, 95% CI = 0.43 to 0.66; moderately to severely frail adjusted OR = 0.18, 95% CI = 0.11 to 0.30).

Conclusions: Remarkably, less than 40% of nonfrail patients with nonmetastatic pancreatic ductal adenocarcinoma underwent surgery, suggesting that curative-intent treatment remains infrequent even among lower-risk adults. Frailty is also common and strongly associated with decreased odds of surgical resection.