Use of supportive care medications is associated with pancreatic cancer tumor location at diagnosis

Background: Pancreatic cancer (PC) often presents with non-specific symptoms that vary by tumor location. Tumors in the body and tail often present later and are more commonly associated with pain, nausea, or cachexia. Supportive care medications (SCMs) such as psychotropics, pain relief medications, antinausea agents, and appetite stimulants ae commonly used to manage these symptoms yet little is known about whether prescribing patterns differ by tumor location. We evaluated whether pancreatic tumor location at diagnosis is associated with subsequent use of SCMs among older adults with pancreatic cancer. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2007-2019). The study included patients aged ≥65 years old with incident pancreatic cancer and continuous Medicare parts A, B, and D coverage for 3 months before diagnosis. Patients with another cancer diagnosis within 6 months or missing baseline data were excluded. Pre-diagnosis SCM use was ascertained from Medicare Part D prescription claims. Tumor location at diagnosis were categorized as pancreatic head (C250), body (C251), tail (C252), or other (C253, C254, C257, C258, C679). We used multivariable logistic regression to evaluate the association between SCM use and tumor location adjusting potential confounders. Results: Compared to tumors in the pancreatic head, tumors in the body were associated with higher odds of receiving most SCM classes including psychotropic medications (OR for any psychotropic: 1.13; 95% CI: 1.08-1.19), pain medications (OR for any pain medication: 1.25; 95% CI: 1.19-1.31), anti-nausea agents (OR: 1.08; 95% CI: 1.03-1.13), appetite stimulants (OR: 1.16; 95% CI: 1.11-1.21). Tail tumors were associated with increased use of anxiolytics (OR: 1.07; 95% CI: 1.00 - 1.14) and non-opioid analgesics (OR: 1.25; 95% CI: 1.15-1.37), but lower odds of anti-nausea use (OR: 0.85; 95% CI: 0.81-0.89). Tumors in other locations generally had lower odds of SCM use across nearly all categories. Conclusion: Pancreatic cancer tumor location at diagnosis is associated with distinct patterns of supportive care medication use. Patients with tumors in the body of the pancreas were more likely to receive symptom-directed therapies than those with head tumors while those with tail or other locations had more variable patterns. These findings suggest that tumor location may influence supportive care needs and should be considered when tailoring symptom management strategies.