Real-world outcomes following adjuvant chemotherapy for resected pancreatic cancer in a centralised oncology service

BACKGROUND: Pancreatic cancer remains a significant challenge to diagnose and treat, with considerable regional variation in management and outcomes. This study aimed to evaluate real-world outcomes of patients receiving adjuvant treatment for pancreatic cancer at a single centre in Northwest England over an 11-year period. METHODS: Data were collected retrospectively on all patients who underwent surgery for pancreatic ductal adenocarcinoma between 2009 and 2020. Collected data included patient demographics, surgical details and adjuvant treatment received, including number of chemotherapy cycles and dose reductions. RESULTS: 30-day/inpatient mortality was low (2.4%). Adjuvant chemotherapy delivery rates were high (82%) with 67.4% of patients completing the intended number of cycles. There was no additional survival benefit for patients who started chemotherapy within 8 weeks post-surgery compared to those who began later. Dose reductions did not impact survival, provided patients completed the full course of treatment (mOS 27.5 months vs. 28.5 months; HR 1.14, 95% CI 0.76-1.70 p = 0.513). Following centralisation of care, a greater proportion of patients commenced adjuvant treatment (86% vs 69% p < 0.05). CONCLUSION: A high proportion of patients received adjuvant treatment, with a centralised clinic model leading to increased rates of adjuvant chemotherapy delivery. Completion of the full chemotherapy course was more critical than dose intensity. Larger prospective studies are needed to investigate the factors contributing to regional variations.