Pancreatic Cancer in the Very Elderly Patient: Challenges and Solutions
Pancreatic cancer is the fourth leading cause of cancer related mortality
with 44,000 American and 250,000 worldwide diagnoses annually.
A disturbing increase in the US incidence of pancreatic cancer has been
noted in recent years. Surgical therapy remains the only chance at cure
for early stage disease, but unfortunately only 9% of patients present with localized disease.
The advanced age of diagnosis frequently complicates potential therapies
due to comorbidities, frailty, or perceived risk. Although surgical morbidity
has dramatically decreased, 5-year survival remains a dismal 7.8%.
Current data from the Surveillance, Epidemiology, and End Results Program reveals
that only 31.7% of patients diagnosed with pancreatic cancer
are under age 64, while 26.8% will be diagnosed between age 65-74, another 26.1% will be
diagnosed between age 75-84, and 13.5% will be diagnosed at an age above 85.
The average age at diagnosis is now 71 years of age.
With rising incidence in an aging population
we have sought to review the best management strategy
for elderly patients with pancreatic cancer.
The term “elderly” is inconsistently defined throughout the literature.
Prior studies have used a range of ages from 65-90 years to demarcate “elderly”,
but more recent literature stresses functional status over numerical age.
Further confounding the discussion of the elderly patient with pancreatic
cancer is the wide variety of pathology combined with anatomic considerations
and the implications for surgical resection, research, and outcomes.
Surg Res Open J. 2016; 3(1): 4-12. doi: 10.17140/SROJ-3-116