Pancreatic Cancer Survival Rates: What Do They Really Mean?

In-Depth Insights |  Written by Lola Rahib, PhD

The American Cancer Society estimates that in 2020, 57,600 people in the U.S. will be diagnosed with pancreatic cancer and 47,050 will die from the disease. But not everyone’s pancreatic cancer is the same. Understanding what survival rates mean—and which factors can impact them—could help you navigate your or your loved one’s disease.

What is the five-year relative survival rate for pancreatic cancer?

In the U.S., the overall five-year relative survival rate for pancreatic cancer is 9%, meaning that about nine out of 100 patients will still be alive five years after their diagnosis. This rate refers to all stages and types of pancreatic cancer diagnoses. However, survival rates do vary between stages and according to other factors, such as age, overall health, and location of the primary tumor within the pancreas.

Pancreatic tumors can be ‘exocrine’ or ‘endocrine,’ depending on the type of pancreas cell where they start. The most common type of pancreatic cancer is an exocrine form known as adenocarcinoma. Pancreatic neuroendocrine tumors are of the endocrine type and are much rarer, but typically have a better prognosis.

How does survival rate depend on stage at diagnosis?

Five‐year pancreatic cancer relative survival rates are 37% for patients with localized disease (when the tumor can be removed with surgery), 12% for patients with regional disease (when the cancer has spread to nearby structures or lymph nodes), and 3% for those with distant (metastatic) pancreatic cancer. Pancreatic cancer is most often diagnosed at an advanced stage; 53% of patients are diagnosed with stage 4 (metastatic) pancreatic cancer, whereas only 10% of patients are diagnosed at the early stage when surgery is possible. Because the majority of patients are diagnosed at stage 4, which has the lowest survival rate, the overall survival rate for all stages is 9%—lower than the average survival rate of all the stages.

How are survival rates determined?

In the United States, cancer survival rates are calculated with data collected by the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. SEER collects data on all types of cancers from different geographical locations and sources throughout the country. While it is not yet feasible to obtain data for every single patient in the U.S., SEER data covers large proportions of the country’s population and can be statistically analyzed to make reasonably accurate estimates of overall cancer survival rates.

The SEER program began collecting cancer data in 1973 in seven cancer registries—systems for collecting and managing cancer data—representing five states and two metropolitan areas. Since then, more registries representing different geographical locations have been added, and to date, 21 registries have collected cancer data through SEER. Different databases represent groups of these registries in different combinations used to analyze survival data and other statistics.

Sometimes survival rates vary slightly based on the SEER database used. For example, pancreatic cancer five-year survival is reported to be 10% when using the SEER 9 database which contains 9 registries and represents about 9% of the U.S. population, but it is reported to be 9% when using SEER 18, which contains 18 registries and represents about 28% of the population.

When looking at five-year cancer survival rates, it is important to keep in mind that they represent patients who were diagnosed several years back. Patients are followed for five years from their date of diagnosis, and data collection, analysis, and publication can take a few additional years. That means that data collected for patients who are diagnosed today will not be reported for several years. In that time, advances in treatment may occur; patients who were treated for pancreatic cancer several years back did not have access to the same treatments available today.

Other survival rate measurements with lower lag times are one- and two-year survival rates, overall survival, and progression-free survival (the percentage of patients whose cancer has not worsened over a given period of time). These rates are useful for looking at trends and assessing shorter-term improvements. The most recent available one-year overall survival rate for pancreatic cancer is 35% for patients diagnosed in 2015. The two-year survival rate is 19% for patients diagnosed in 2014. Again, these rates are cumulative for all stages of pancreatic cancer and do not represent one specific stage.

What can patients do to improve their chances of survival?

It is important to remember that each patient is different and that other factors besides stage of disease—including age, overall health, and response to treatment,—can impact survival. If you are diagnosed with pancreatic cancer, it is important to understand your treatment options and be informed about your disease.

  • Get comprehensive molecular testing: Molecular testing of a patient’s tumor tissue could indicate potential treatment options specific to the patient. (Genetic testing for inherited mutations should also be done, but most alterations in a tumor are not inherited.) Molecular testing identifies molecular alterations, such as mutations in the DNA of the tumor, some of which can be treated with specific medications. Patients who have molecular alterations that are treated with these specific medications have better outcomes than those who have the alterations and are not treated with a “matched” or “personalized” therapy. Therefore, it is very important to know if a particular alteration is in a patient’s tumor so that they can receive the medication to target it, if one is available. Common matched therapies include PARP inhibitors that target DNA damage repair genes, such as BRCA1 or BRCA2 mutations, and immune checkpoint inhibitors for treating “MSI- high” tumors. Cancer Commons can help you explore and identify personalized treatment options.
  • Receive treatment from a multi-disciplinary team at high-volume center: Patients can increase their chances of survival by receiving treatment from a multi-disciplinary team at a cancer center that cares for large numbers of pancreatic cancer patients. A multi-disciplinary team includes healthcare professionals representing a variety of areas of expertise, such as medical oncologists, surgeons, radiation oncologists, dietitians, and palliative-care specialists. High-volume centers are cancer centers that care for a high number of pancreatic cancer patients. These centers usually have experienced specialists who provide treatment and care for pancreatic cancer patients. Surgical resections performed at high-volume centers have better survival. Improved survival rates have also been reported for metastatic pancreatic cancer patients receiving care in high-volume centers.
  • Enroll in a clinical trial: The National Comprehensive Cancer Network (NCCN) guidelines recommend that pancreatic cancer patients enroll in a clinical trial. Pancreatic cancer patients who enroll in a clinical trial have better survival outcomes than those who don’t. Some of this survival benefit may be due to “healthier” patients being eligible for a clinical trial. Nonetheless, enrolling in a clinical trial allows patients to try novel treatments that are not yet available through standard care. Additionally, with molecular testing, patients may be able to find a clinical trial testing a therapy that targets a specific molecular alteration present in their tumor. Cancer Commons can help you find clinical trials that may be a good fit for you or your loved one.

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References:

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