The impact of age on quality of life, 90-day mortality, adjuvant chemotherapy, and survival after treatment for localized pancreatic cancer: A nationwide analysis

Background Pancreatic cancer has a poor prognosis. Multiple treatment modalities are available, their impact on health-related quality of life (HRQoL) and overall survival (OS) in older patients remains unclear. This study compared HRQoL, postoperative mortality, adjuvant chemotherapy use and OS after various treatment strategies between elderly and younger patients with localized pancreatic cancer. Methods In this nationwide cohort study (2015–2023), patients with localized pancreatic cancer (resectable, borderline resectable and locally advanced disease) treated with surgical resection, chemotherapy alone, or stereotactic body radiation therapy (SBRT) were included and stratified into elderly (≥75years) and younger (<75years). The primary outcome was HRQoL assessed with the EORTC QLQ-C30. Secondary outcomes included OS, 90-day mortality, and adjuvant chemotherapy. Linear mixed models with Bonferroni correction (p < 0.013) evaluated HRQoL. Logistic regression assessed 90-day mortality and adjuvant chemotherapy. OS was analyzed using Cox proportional hazards models. Results 5217 patients were included (3496 resection, 1459 chemotherapy-only, and 262 SBRT). Following resection, elderly reported less dyspnea at 0–3 months but worse role functioning, more fatigue and pain at 9–12 months. No differences were observed between patients treated with chemotherapy only. Elderly patients had higher 90-day postoperative mortality (adjusted OR:1.6, 95%CI[1.2–2.23],p = 0.003) and were less likely to receive adjuvant chemotherapy (adjusted OR:0.4, 95%CI[0.3–0.4],p < 0.001). Age was not independently associated with OS across treatment groups. Conclusion Elderly patients reported comparable longitudinal HRQoL as to younger patients. Higher age was associated with higher 90-day mortality and less use of adjuvant chemotherapy, but it was not independently associated with overall survival. These findings support individualized shared decision-making and suggest that age alone should not preclude treatment.