To describe time-trends in incidence, characteristics, treatments, and survival in pancreatic cancer patients in Denmark during 1980–2019.
A nationwide population-based cohort study of all Danish patients diagnosed with exocrine pancreatic cancer during the study period. Data was obtained from individual-level cross linkage between Danish healthcare registries. We present descriptive characteristics and survival estimates, which was obtained using the Kaplan-Meier estimator and Cox proportional hazards regression models.
During the study period, 32,107 patients were diagnosed with pancreatic cancer. In the most recent period, the age-standardized incidence rate was 17.7 per 100,000 person-years. Throughout the study period, between 18.4% and 27.5% of patients had no tumor staging performed, and approximately half of the patient were only offered best supportive care. The proportion of patients treated with surgery doubled during the study period, and the use of adjuvant and neoadjuvant oncological therapy increased substantially. Median survival after surgical resection also increased to 25.8 months in the most recent time period.
Pancreatic cancer incidence is increasing in Denmark, and this increase is projected to continue. The proportion of patients offered curative-intent treatment increased, which translates into an increase in overall survival. All numbers are comparable to best international standards.
- • Pancreatic cancer incidence is the 4th cause of cancer-related deaths.
- • We examined trends in incidence, characteristics, and mortality during almost 40 years.
- • Population-based Danish estimates were comparable to international standard.
- • There is a continued need to facilitate the use of chemotherapy and surgery.
Pancreatic cancer is the fourth leading cause of cancer-related death in the Western world, and it is projected to increase to the second leading cause by 2030. This is a result of an ageing population and lack of progress in pancreatic cancer treatment compared to other cancers. The 5-year survival rate is less than 10%. .
Whereas survival estimates appear to be somewhat similar on a global level, previous research have shown that the incidence of pancreatic cancer varies greatly. The incidence seem to be highest in the United States and Europe, compared with other parts of the world. This may both be due to true differences in incidence rates, but could also be due to differences in reporting and diagnostic approaches. Despite increasing incidence rates, the chance of survival has seen limited improvements and remains low. One study from England found that 5-year survival in pancreatic cancer patients increased slightly from 2.3% in the 1970′s to around 3% in the early 2000′s. The prognosis is more optimistic following curative-intent surgery, where the 5-year survival have increased to approximately 20%. .
To inform healthcare planners and decision-makers, and to identify areas for further research, it is important to have population-based estimates of cancer incidence, characteristics, and mortality. Denmark has a universal tax-financed healthcare system with free and equal access, providing an ideal opportunity to study such research questions. The most recent study on pancreatic cancer incidence and mortality in Denmark was conducted on patients diagnosed during 1998–2009, but was restricted to only two of five geographical regions. .
In the present study, we aimed to examine time-trends in incidence, characteristics, and survival in pancreatic cancer patients during 1980–2018 with a special focus on examining survival in patients undergoing surgical treatment.