Survival Impact of Gastrostomy Tube Feeding in Stage IV Pancreatic Adenocarcinoma
Direct data demonstrating that gastrostomy tube placement for feeding improves survival in elderly patients with stage IV pancreatic adenocarcinoma receiving systemic chemotherapy are not available in the reviewed literature.
Evidence for Survival Benefit After PEG/Gastrostomy in Older Patients
A systematic review/meta-analysis of percutaneous endoscopic gastrostomy (PEG) placement in older persons found that cohort studies comparing survival in PEG-fed versus non-PEG patients did not demonstrate a survival benefit. [1]
In that analysis, pooled survival after PEG placement was 81% at 1 month and 38% at 12 months, with advanced age and malignancy repeatedly associated with poorer survival after PEG. [1]
Evidence Relevant to Advanced Pancreatic Cancer and Gastrostomy (Malignant Bowel Obstruction)
In a SEER-Medicare cohort of older adults with stage IV ovarian or pancreatic cancer hospitalized for malignancy-associated bowel obstruction, venting gastrostomy tube (VGT) placement was associated with worse survival compared with medical management. [2]
In that cohort, median survival after the first bowel obstruction admission was 72 days for medical management versus 38 days for VGT. [2]
After adjustment, VGT was associated with increased hazard of death versus medical management (adjusted hazard ratio 1.86; 95% CI 1.62 to 2.12; p<0.001). [2]
Feeding Intent Versus Venting Intent
Hospital claims do not specify feeding versus venting intent for gastrostomy placement, but venting intent was inferred for gastrostomy performed during malignancy-associated bowel obstruction admissions in the SEER-Medicare study. [2]
Because of this inference, the survival findings for VGT in advanced pancreatic cancer primarily address palliative decompression for obstruction rather than feeding tube placement to support systemic chemotherapy. [2]
Applicability to “Stage IV Pancreatic Adenocarcinoma on Systemic Chemotherapy”
The available PEG survival synthesis addresses older persons broadly rather than stage IV pancreatic adenocarcinoma receiving systemic chemotherapy. [1]
The available stage IV pancreatic cancer gastrostomy survival cohort addresses hospitalization for malignant bowel obstruction and compares VGT versus medical management, which is not equivalent to feeding gastrostomy placement during chemotherapy. [2]
Clinical Conclusion Supported by Available Data
No evidence was identified demonstrating that gastrostomy tube placement for feeding improves survival in elderly patients with stage IV pancreatic adenocarcinoma receiving systemic chemotherapy. [1], [2]
Key Data Points to Communicate
PEG survival evidence in older persons shows no demonstrated survival benefit in comparative cohorts and indicates that most older patients selected for PEG do not survive to 1 year (pooled 12-month survival 38%). [1]
In stage IV pancreatic cancer with malignant bowel obstruction, venting gastrostomy tube placement was associated with shorter median survival (38 days) and higher adjusted hazard of death (HR 1.86) versus medical management. [2]