Patients aged 65 years and older with histologically confirmed PDAC diagnosed between 2007 and 2011 were selected (Fig. 1). The last date of diagnosis in our study was in December 2011 because that is when the verified dataset from SEER ended at the time this study was initiated. Only patients with one primary cancer were included to avoid the confounding effect of metachronous and synchronous lesions. PDAC was selected using the following International Classification of Diseases for Oncology, Second Edition (ICD-O-2) histology codes: 8000, 8010, 8140, 8500, 8550, and 8560. Patients without Medicare Part B were excluded to account for missing outpatient medical claims. Individuals in health-care maintenance organization (HMO) were also excluded to ensure all claims were captured. Next, we further limited patients by Medicare Part D coverage to account for prescription medication pharmacy claims (Fig. 1). For our primary analysis, we limited coverage to patients who had Medicare Part D in the 6 months prior to cancer diagnosis. As a subgroup analysis, we then further limited patients to Medicare Part D coverage in the 6 months before and 6 months after diagnosis so as to capture medication claims in the 12-month period surrounding cancer diagnosis.

Cohort selection. PDAC pancreatic ductal adenocarcinoma, HMO health-care maintenance organization.

All methods were carried out in accordance with relevant guidelines and regulations and all experimental protocols were approved by the Icahn School of Medicine at Mount Sinai Institutional Review Board (IRB). A waiver of informed consent was approved by the Icahn School of Medicine Mount Sinai IRB as this study was a retrospective chart review of a SEER-Medicare dataset and contains no personal identifiers.

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