A recent scoping review and evidence map published in Supportive Care in Cancer identified an alarming lack of research reporting results other than survival outcomes when evaluating systemic oncological treatments (SOT) versus best supportive care (BSC) for patients with advanced pancreatic cancer (PC).
Pancreatic is the least treatable form of cancer and has the highest ratio of incidence-to-mortality of any solid tumor. Furthermore, it is often identified only in the late stages, with the estimated 5-year survival rate around 3% for the advanced stage of disease. Therefore, many patients diagnosed with PC already find themselves in the end-of-life (EOL) period.
Given the prognosis, patients with advanced stage PC, their treatment teams, and their caregivers face a difficult choice. Do they focus on overall survival or quality issues? In other words, should these late-stage patients undergo SOT, which is associated with significant toxicity, or should they focus on BSC, which is generally more focused on outcomes such as quality of life, quality of death, palliative care, and symptom control?
The Appropriateness of Systemic Oncological Treatments for Advanced Cancer (ASTAC) Research Group sought to answer this question by synthesizing the results of available literature on the topic. Searching major reporting databases, they performed a scoping review of systematic reviews, randomized-controlled trials, and quasi-experimental and observational studies evaluating SOT versus BSC or no treatment in patients with advanced stage PC.
Search results returned 177 eligible studies of all cancer locations. Of these studies, the researchers identified 43 including participants with PC. Two of them were systematic reviews, 16 were randomized-controlled trials, 4 were quasi-experimental studies, 20 were observational studies, and 1 was a protocol for a quasi-experimental study.
Reporting their findings, the team stated, “We found absolute evidence gaps, meaning no study reporting data, in the following outcomes: quality of death for all SOTs; quality of life for immunotherapy, and symptoms related to the disease, admissions to the hospital and quality of death for immunotherapy and biological/targeted therapies.”
Almost all studies focused primarily on survival as the sole outcome. In addition, very few studies looked at BSC as an option at all, perhaps because of ethical concerns. However, as patient-centered care becomes more widely recognized as a primary goal, survivorship will need to be considered as only one facet of the treatment plan.
The research group concluded that “There is increasing recognition of the need to prioritise patient-centered communication and to have a focus on the patients’ goals of care. For patients with advanced PC with a poor prognosis, these goals inevitably vary and may not necessarily be related only to an increase in survival. Based on the results of our study, these other goals of care are not sufficiently reported.”
