Abstract
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) primarily affects older adults and has a poor prognosis. Although tools like geriatric assessments and electronic patient-reported outcomes (ePRO) can guide treatment, they are underutilized in clinical practice. This secondary analysis of the INSPIRE pilot intervention, a pilot intervention that assessed the utility of incorporating data on patient preferences and frailty into multidisciplinary tumor board (MDTB) discussions, evaluated the clinical impact of incorporating patient preferences and frailty data into MDTB discussions. METHODS: The study included patients aged ≥ 60 years with PDAC enrolled in the INSPIRE intervention at the University of Alabama at Birmingham. Patients discussed at MDTBs with adequate medical records who did not forgo treatment initially were included. A control group comprised patients who completed preference and frailty surveys but whose ePRO data were not presented at MDTBs. Outcomes analyzed included treatment consistency with preferred National Comprehensive Cancer Network (NCCN) regimens based on fitness, unplanned treatment modifications, and healthcare utilization within six months of treatment initiation. Data were extracted from medical records and statistical analysis employed log-rank tests from cumulative incidence functions. RESULTS: Among 121 patients (24 intervention, 97 controls), the median age was 70 years. Compared to controls, the intervention group had fewer comorbidities (8% vs. 25% with no comorbidities, V = 0.22), a higher proportion of non-White patients (42% vs. 25%, V = 0.15), more resectable disease (48% vs. 35%, V = 0.14), and higher frailty rates (42% vs. 31%, V = 0.11). Intervention patients showed slightly higher consistency with NCCN preferred regimens based on fitness (63% vs. 60%, V = 0.02), fewer unplanned treatment modifications (54% vs. 68%, V = 0.12), and lower hospital admissions (33% vs. 50%, V = 0.13). CONCLUSION: The INSPIRE intervention demonstrated promising signals when aligning treatment regimens with patient capabilities and preferences, potentially reducing unplanned treatment modifications and hospital admissions. Larger studies are needed to confirm these exploratory results and assess broader applicability.