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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2016; 22(2): 764-775
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.764
Management of pancreatic cancer in the elderly
Oliver Higuera, Ismael Ghanem, Rula Nasimi, Isabel Prieto, Laura Koren, Jaime Feliu
Oliver Higuera, Ismael Ghanem, Jaime Feliu, Department of Medical Oncology, La Paz University Hospital, 28046 Madrid, Spain
Rula Nasimi, Isabel Prieto, Department of General Surgery, La Paz University Hospital, 28046 Madrid, Spain
Laura Koren, Department of Radiology, 12 de Octubre University Hospital, 28041 Madrid, Spain
Author contributions: Higuera O, Ghanem I, Nasimi R, Prieto I, Koren L and Feliu J performed manuscript writing and reviewing.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jaime Feliu, MD, PhD, Department of Medical Oncology, La Paz University Hospital, 216 Paseo de la Castellana St, 28046 Madrid, Spain. jaime.feliu@salud.madrid.org
Telephone: +34-91-7277516 Fax: +34-91-3585204
Received: April 29, 2015
Peer-review started: May 12, 2015
First decision: June 2, 2015
Revised: October 3, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: January 14, 2016
Abstract

Currently, pancreatic adenocarcinoma mainly occurs after 60 years of age, and its prognosis remains poor despite modest improvements in recent decades. The aging of the population will result in a rise in the incidence of pancreatic adenocarcinoma within the next years. Thus, the management of pancreatic cancer in the elderly population is gaining increasing relevance. Older cancer patients represent a heterogeneous group with different biological, functional and psychosocial characteristics that can modify the usual management of this disease, including pharmacokinetic and pharmacodynamic changes, polypharmacy, performance status, comorbidities and organ dysfunction. However, the biological age, not the chronological age, of the patient should be the limiting factor in determining the most appropriate treatment for these patients. Unfortunately, despite the increased incidence of this pathology in older patients, there is an underrepresentation of these patients in clinical trials, and the management of older patients is thus determined by extrapolation from the results of studies performed in younger patients. In this review, the special characteristics of the elderly, the multidisciplinary management of localized and advanced ductal adenocarcinoma of the pancreas and the most recent advances in the management of this condition will be discussed, focusing on surgery, chemotherapy, radiation and palliative care.

Keywords: Pancreatic ductal adenocarcinoma, Elderly, Management, Treatment, Pancreatic cancer

Core tip: Pancreatic cancer is a disease that mainly affects the elderly. The older patients have different biological, functional and psychosocial characteristics compared with the young population. The infrequent participation of these patients in clinical trials have raised challenges in the management of this disease. In this review, the special features of the elderly as well as the current multidisciplinary management of pancreatic cancer will be discussed.