Pancreatic cancer survival in central and northern Denmark from 1998 through 2009: a population-based cohort study
Deirdre P Cronin-Fenton1, Rune Erichsen1, Frank V Mortensen2, Sarunas Dikinis3, Mette Nørgaard1, Jacob Jacobsen1
1Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Department of Gastrointestinal Surgery L, Aarhus University Hospital, Denmark; 3Department of Gastrointestinal Surgery A, Aalborg Hospital, Aarhus University Hospital, Denmark
Objectives: Pancreatic cancer has a relatively low incidence but ranks fourth among cancer-related deaths in western countries. In Denmark, cancer survival generally is lower than in other countries with comparable health care systems. As a result, in 2000, a national strategy to improve cancer survival was introduced. Here we examine time trends in survival and relative mortality among pancreatic cancer patients, using Danish population and medical databases.
Methods: Using the Danish National Patient Registry (DNPR), we identified all incident pancreatic cancer patients (n = 2968) diagnosed between 1998 and 2009 in the Central and North Denmark Regions. We computed the 1-, 3-, and 5-year survival and relative mortality (MRR) and associated 95% confidence intervals (CI) adjusting for age and gender. Among surgical patients, we also computed 30-day mortality and 30-day MRR.
Results: Median age at diagnosis was approximately 71 years. The annual number of patients increased from 189 in 1998–2000 to 302 in 2007–2009. There was a slight improvement in 1-, 3-, and 5-year survival over time from 14.8% to 17.7%; 3.5% to a predicted 5.6%; and from 2.0% to a predicted 3.8%, from 1998–2000 to 2007–2009, respectively. Correspondingly, the adjusted relative mortality decreased from 1998–2000 to 2007–2009. Thirty-day post-operative mortality decreased from 12.2% in 1998–2000 to 5.8% in 2007–2009, corresponding to a 30-day MRR of 0.38, 95% CI = 0.09, 1.6 in 2007–2009.
Conclusion: There was a slight, albeit modest, improvement in survival and relative mortality in pancreatic cancer patients between 1998 and 2009. As we lacked staging information, it is not clear if this improvement is attributable to earlier stage at diagnosis. However, these improvements likely reflect the national cancer strategy which aimed to centralize cancer services and involved the introduction of palliative and adjuvant chemotherapy for pancreatic cancer in Denmark. The dismal prognosis of pancreatic cancer means that efforts to improve survival need to be intensified.
Keywords: pancreatic cancer, survival, relative mortality, epidemiology
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