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Introduction: Multiple prospective, randomized trials have demonstrated that the addition of adjuvant therapy after surgical resection of pancreatic cancer improves survival compared to surgery alone. However, the optimal type of adjuvant therapy, chemotherapy alone or chemotherapy combined with chemoradiation therapy, remains controversial. Our aim was to determine whether the type of adjuvant therapy for pancreatic cancer given in the United States has changed by examining treatment trends using the National Cancer Data Base.
Methods: The National Cancer Data Base (NCDB) is a national oncology outcomes database for over 1,500 Commission on Cancer-accredited cancer programs. Patients diagnosed with stage 1-2 pancreatic adenocarcinoma between 2003-2009 were selected from the NCDB Hospital Comparison Benchmark Reports. Attention was paid to the initial treatment regimen, such as surgery alone, surgery plus chemotherapy, or surgery plus chemoradiation. In addition, data on hospital setting (teaching-research hospitals vs. community hospitals) were collected and analyzed. The Cochran-Armitage test for trend was used to assess changes in treatment over time.
Results: 47, 086 patients with stage 1-2 pancreatic adenocarcinoma were included in the analysis. Between 2003-2009, the use of surgery alone as first course treatment of stage 2 disease decreased significantly at both teaching-research hospitals and community hospitals by nearly 25% (p<0.0001 for both cases). In the same period, the use of chemotherapy in addition to surgery as treatment of stage 1 and 2 disease increased two-fold at both types of hospitals (p<0.0001 for all cases). Treatment with surgery plus chemoradiation decreased significantly for both stages in both hospital settings by approximately 30% (p<0.05 for all cases). Non-surgical treatment for stage 2 disease was surprisingly high and significantly increased over time (p<0.0001 for both), ranging from approximately 30-37% at teaching-research hospitals and 40-49% at community hospitals.
Conclusion: Data from the NCDB from 2003-2009 illustrate changes in the adjuvant treatment of pancreatic cancer. There is an alarmingly high rate of non-surgical therapy for stage 1 and 2 disease. The use of chemotherapy alone as adjuvant therapy increased whereas the use of multimodality therapy decreased.

		Surgery Only		Surgery plus Chemotherapy		Surgery plus Chemoradiation		No Surgical Therapy
		Cochran-Armitage Test for Trend p value	Percent Change between 2003 and 2009	Cochran-Armitage Test for Trend p value	Percent Change between 2003 and 2009	Cochran-Armitage Test for Trend p value	Percent Change between 2003 and 2009	Cochran-Armitage Test for Trend p value	Percent Change between 2003 and 2009
Stage 1	Teaching-Research Hospitals	0.1069	-3.14%	<.0001	235.48%	0.0006	-27.70%	0.162	-1.42%
	Community Hospitals	0.6323	-10.86%	<.0001	261.12%	0.0002	-35.31%	0.145	3.53%
Stage 2	Teaching-Research Hospitals	<.0001	-23.05%	<.0001	229.31%	<.0001	-34.21%	<.0001	16.89%
	Community Hospitals	<.0001	-23.97%	<.0001	174.81%	<.0001	-30.35%	<.0001	15.94%

No Surgical Therapy includes no first course therapy, chemotherapy only and chemoradiation only