Uptake and patterns of use of gemcitabine for stage IV pancreatic cancer.
e15074 Background: Gemcitabine was approved by the FDA in 1996 and subsequently became the standard of care for patients with advanced pancreatic cancer. We investigated the frequency and predictors of gemcitabine use among the elderly with stage IV pancreatic cancer. Methods: We used the SEER-Medicare database to identify subjects >65 years who were diagnosed with stage IV pancreatic cancer between 1/1/98-12/31/05, and survived for >30 days following diagnosis. After excluding patients who received non-gemcitabine chemotherapy, we used multivariate logistic regression models to analyze the association between patient and tumor characteristics and receipt of gemcitabine compared to no chemotherapy. Results: Among 3,208 patients analyzed, 1,614 (50.3%) received gemcitabine chemotherapy, 1,480 (46.1%) received no chemotherapy; 114 (3.5%) received non-gemcitabine therapy and were excluded from multivariate analysis. Among patients diagnosed early in the study period (1998-2000) the rate of gemcitabine use was 44.9%. In multivariate analysis, gemcitabine use was not associated with gender, race, tumor histology, or increasing comorbidities. Unmarried patients were less likely to receive gemcitabine (OR=0.65, 95% CI 0.55-0.76), and use decreased with increasing age (for those 75-79, OR=0.72. 95% CI 0.58-0.90, for those 80-84, OR=0.38, 95% CI 0.30-0.49, for those >84, OR=0.21 95%CI 0.15-0.30) compared to those 65-69. Patients diagnosed in 2004-2005 (OR= 1.51, 95% CI 1.23-1.84) were more likely to receive gemcitabine compared to those diagnosed in 1998-2000. Higher socioeconomic status were associated with increased utilization of gemcitabine (highest quintile OR=2.14, 95% CI 1.60-2.85, second and third quintile OR=1.45, 95%CI 1.10-1.93, compared to lowest quintile.) Conclusions: Although chemotherapy for stage IV pancreatic cancer confers a small survival benefit, uptake of gemcitabine was rapid with 55% of elderly patients receiving this therapy by 2004-2005. Future studies should explore the reasons behind the increased use in patients with higher socioeconomic status.