Palliative chemotherapy for pancreatic cancer in an integrated healthcare system.

e16371 Background: Palliative systemic therapy for pancreatic ductal adenocarcinoma (PDAC) aims to extend survival and alleviate symptoms, but real-world benefits can vary across patient subgroups, particularly older adults. We evaluated overall survival (OS) associated with receipt of palliative chemotherapy within an integrated healthcare system. Methods: We conducted a retrospective analysis of patients with PDAC treated in an integrated health network. Patients were categorized by receipt of any palliative chemotherapy versus no chemotherapy. The primary endpoint was mean OS from the index date of palliative intent (or comparable reference date for non-treated patients). A prespecified subgroup analysis assessed outcomes among patients aged ≥70 years. Statistical comparisons were performed using two-sided tests with significance set at p < 0.001. Results: In the overall cohort, palliative chemotherapy was associated with longer survival compared with no chemotherapy (mean OS 12.9 months vs 5.2 months, p < 0.001). In the subgroup aged ≥70 years, the pattern differed: patients who received palliative chemotherapy had shorter mean OS compared with those who did not (3.2 months vs 9.8 months, p < 0.001). These findings suggest potential age-related differences in treatment effect or selection factors in clinical practice. Conclusions: Within this integrated healthcare system, palliative chemotherapy for PDAC was associated with improved mean OS overall, but not among patients aged ≥70 years, in whom shorter survival was observed with treatment. The contrasting outcomes underscore the need for careful patient selection, optimization of supportive care, and consideration of geriatric assessment when making palliative treatment decisions for older adults. Future work should incorporate performance status, comorbidity burden, regimen intensity, and goals-of-care discussions to clarify drivers of benefit and harm in this population.