Journal article
Disparities in Pancreas Cancer Care
Annals of surgical oncology, Vol.20(6), pp.2078-2087
06/01/2013
DOI: 10.1245/s10434-012-2843-z
PMID: 23579872
Abstract
Prior literature shows demographic differences in patients surgically treated for pancreatic cancer (PC). We hypothesized that socioeconomic disparities also exist across all aspects of PC care, in both surgically and non-surgically treated patients.
We identified a cohort of patients with American Joint Committee on Cancer (AJCC) stage I-IV PC in the 1994-2008 California Cancer Registry. We used multivariate logistic regression to examine the impact of race, sex, and insurance status on (1) resectability (absence of advanced disease), (2) receipt of surgery, and (3) receipt of adjuvant/primary chemotherapy (+/- radiotherapy).
Among 20,312 patients, 7,585 (37 %) had resectable disease; 40 % who met this definition received surgery (N = 3,153). On multivariate analysis, males were less likely to present with resectable tumors [odds ratio (OR) 0.91, 95 % confidence interval (CI) 0.85-0.96], but sex did not otherwise predict treatment. Black patients were as likely as White patients to show resectable disease, yet were less likely to receive surgery (OR 0.66, 95 % CI 0.54-0.80), and adjuvant (OR 0.75, 95 % CI 0.58-0.98) or primary chemotherapy +/- radiation. Compared with Medicaid recipients, non-Medicare/Medicaid enrollees were more likely to receive surgery (OR 1.7, 95 % CI 1.4-2.2), and the uninsured were less likely to receive adjuvant therapy (OR 0.54, 95 % CI 0.30-0.98).
Though Black patients appear to present with comparable rates of resectability, they receive care that deviates from current guidelines. Insurance status is associated with inferior profiles of resectability and treatments. Future policies and research should identify effective strategies to ensure receipt of standard care.
Details
- Title: Subtitle
- Disparities in Pancreas Cancer Care
- Creators
- Anasooya Abraham - University of MinnesotaWaddah B. Al-Refaie - University of MinnesotaHelen M. Parsons - University of MinnesotaVikas Dudeja - University of MinnesotaSelwyn M. Vickers - University of MinnesotaElizabeth B. Habermann - University of Minnesota
- Resource Type
- Journal article
- Publication Details
- Annals of surgical oncology, Vol.20(6), pp.2078-2087
- DOI
- 10.1245/s10434-012-2843-z
- PMID
- 23579872
- NLM abbreviation
- Ann Surg Oncol
- ISSN
- 1068-9265
- eISSN
- 1534-4681
- Publisher
- Springer Nature
- Number of pages
- 10
- Grant note
- Enhancing Minority Participation in Clinical Trials (Empact) 5RC2MD004797-02 / National Institute on Minority Health and Health Disparities; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Minority Health & Health Disparities (NIMHD) American Society of Clinical Oncology Foundation
- Language
- English
- Date published
- 06/01/2013
- Academic Unit
- Anatomy and Cell Biology; Surgery
- Record Identifier
- 9985244678002771
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