{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:27:06Z","timestamp":1791894426530,"version":"4.3.4"},"reference-count":33,"publisher":"Harborside Press, LLC","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Pancreatic cancer is an aggressive disease characterized by early and relentless tumor spread, thus leading healthcare providers to consider it a \u201cdistant disease.\u201d However, local pancreatic tumor progression can lead to substantial morbidity. This study defines the long-term morbidity from local and nonlocal disease progression in a large population-based cohort. <jats:bold>Methods:<\/jats:bold> A total of 21,500 Medicare beneficiaries diagnosed with pancreatic cancer in 2000 through 2011 were identified. Hospitalizations were attributed to complications of either local disease (eg, biliary disorder, upper gastrointestinal ulcer\/bleed, pain, pancreas-related, radiation toxicity) or nonlocal\/distant disease (eg, thromboembolic events, cytopenia, dehydration, nausea\/vomiting\/motility problem, malnutrition and cachexia, ascites, pathologic fracture, and chemotherapy-related toxicity). Competing risk analyses were used to identify predictors of hospitalization. <jats:bold>Results:<\/jats:bold> Of the total cohort, 9,347 patients (43.5%) were hospitalized for a local complication and 13,101 patients (60.9%) for a nonlocal complication. After adjusting for the competing risk of death, the 12-month cumulative incidence of hospitalization from local complications was highest in patients with unresectable disease (53.1%), followed by resectable (39.5%) and metastatic disease (33.7%) at diagnosis. For nonlocal complications, the 12-month cumulative incidence was highest in patients with metastatic disease (57.0%), followed by unresectable (56.8%) and resectable disease (42.8%) at diagnosis. Multivariable analysis demonstrated several predictors of hospitalization for local and nonlocal complications, including age, race\/ethnicity, location of residence, disease stage, tumor size, and diagnosis year. Radiation and chemotherapy had minimal impact on the risk of hospitalization. <jats:bold>Conclusions:<\/jats:bold> Despite the widely known predilection of nonlocal\/distant disease spread in pancreatic cancer, local tumor progression also leads to substantial morbidity and frequent hospitalization.<\/jats:p>","DOI":"10.6004\/jnccn.2018.7111","type":"journal-article","created":{"date-parts":[[2019,5,22]],"date-time":"2019-05-22T11:14:04Z","timestamp":1558523644000},"page":"432-440","source":"Crossref","is-referenced-by-count":7,"title":["A Population-Based Study of Morbidity After Pancreatic Cancer Diagnosis"],"prefix":"10.6004","volume":"17","author":[{"given":"Reith R.","family":"Sarkar","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences, UC San Diego Moores Cancer Center, La Jolla, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"Fero","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences, UC San Diego Moores Cancer Center, La Jolla, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Seible","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences, UC San Diego Moores Cancer Center, La Jolla, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Panjwani","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences, UC San Diego Moores Cancer Center, La Jolla, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayna K.","family":"Matsuno","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences, UC San Diego Moores Cancer Center, La Jolla, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences, UC San Diego Moores Cancer Center, La Jolla, California."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"ref41","doi-asserted-by":"crossref","first-page":"IV-55","DOI":"10.1097\/00005650-200208001-00008","article-title":"Utility of the SEER-Medicare data to identify chemotherapy use","volume":"40","author":"Warren","year":"2002","journal-title":"Med Care"},{"key":"ref91","doi-asserted-by":"crossref","first-page":"2939","DOI":"10.1097\/CCM.0b013e3181b7fbbb","article-title":"Immortal time bias in critical care research: application of time-varying Cox regression for observational cohort studies","volume":"37","author":"Shintani","year":"2009","journal-title":"Crit Care 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