Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer

Abstract

Age, sex, and racial/ethnic disparities exist, but are understudied in pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database to determine whether survival and treatment disparities persist after adjusting for demographic and clinical characteristics. Our study included PDAC patients diagnosed between 1992 and 2011. We used Cox regression to compare survival across age, sex, and race/ethnicity within early‐stage and late‐stage cancer subgroups, adjusting for marital status, urban location, socioeconomics, SEER region, comorbidities, stage, lymph node status, tumor location, tumor grade, diagnosis year, and treatment received. We used logistic regression to compare differences in treatment received across age, sex, and race/ethnicity. Among 20,896 patients, 84% were White, 9% Black, 5% Asian, and 2% Hispanic. Median age was 75; 56% were female and 53% had late‐stage cancer. Among early‐stage patients in the adjusted Cox model, older patient subgroups had worse survival compared with ages 66–69 (HR > 1.1, P < 0.01 for groups >69); no survival differences existed between sexes. Black (HR = 1.1, P = 0.01) and Hispanic (HR = 1.2, P < 0.01) patients had worse survival compared with White. Among late‐stage cancer patients, patients over age 84 had worse survival than those aged 66–69 (HR = 1.1, P < 0.01), and males (HR = 1.08, P < 0.01) had worse survival than females; there were no racial/ethnic differences. Older age and minority race/ethnicity were associated with lower likelihood of receiving chemotherapy, radiation, and/or surgery. Age and racial/ethnic disparities in survival outcomes and treatment received exist for PDAC patients; these disparities persist after adjusting for differences in demographic and clinical characteristics.

Occupational class differences in pancreatic cancer survival: A population‐based cancer registry‐based study in Japan

“…Even though we adjusted for clinical stage, microenvironmental progression of the disease by delayed diagnosis/treatment—which may be potentially associated with occupational class—could explain residual differences in prognosis. However, the direction and magnitude of socioeconomic disparities were similar between previous studies (7%‐16% poorer in survivals in low‐SES patients) and our result (11%‐24% poorer in survivals in low‐SES patients) …”

“…However, most of these possible mediating factors were not associated with pancreatic cancer mortality in the Whitehall study . Finally, our analyzed mediating variables were less detailed (eg, binary categories of pathology, stage and treatment) compared with previous studies using detailed classification . Even though we adjusted for clinical stage, microenvironmental progression of the disease by delayed diagnosis/treatment—which may be potentially associated with occupational class—could explain residual differences in prognosis.…”

“…Despite these limitations, the strengths of our study included a relatively large sample size, one of the largest studies conducted for evaluating the association between occupational class and pancreatic cancer survival in the non‐western setting. In addition, although previous studies used a regional‐level (but not individual‐level) socioeconomic indicator and the Japanese national cancer registry has not collected relevant socioeconomic indicators (ie, occupation, educational attainment, or incomes), our study with the population‐based KCR directly measured an individual‐level socioeconomic indicator of the longest‐held occupation, which may introduce less misclassification compared to other alternative occupational indicators (eg, current or most recent jobs) . Further studies should address the occupational class differences in pancreatic cancer survival, trying to use data linkage approach between cancer registries and relevant population‐based data with socioeconomic indicators (such being seen in Nordic countries) .…”

“…Year of diagnosis was adjusted to control for potential secular changes such as occupational structure and treatment regimens. Additionally, based on the methodology used in previous studies, clinicopathological variables were included in the regression analyses as potential mediating variables as follows: pancreatic adenocarcinoma (identified by International Classification of Disease for Oncology, Third edition pathological codes; 8050, 8140‐8147, 8160‐8162, 8180‐8221, 8250‐8507, 8514, 8520‐8551, 8560, 8570‐8574, 8576, 8940, 8941), pathological grade (grade 3 or 4 [high‐grade] vs grade 1 or 2 [low‐grade]), summary stage (regional invasion and distant metastasis [late stage] vs localized [early stage]), and any performed surgery (yes/no) or chemotherapy (yes/no), as well as smoking behaviors (never/former/current). As in previous studies with a population‐based cancer registry that follows the criteria of summary stating system in Surveillance, Epidemiology, and End Results, our staging criteria were different from the TNM staging guidelines because TNM staging was mostly not available through this study period in KCR …”

Regional and racial variations in the utilization of endoscopic retrograde cholangiopancreatography among pancreatic cancer patients in the United States

“…(Figure ). The MEDPAR and outpatient files were used to identify diagnosis and procedural codes using International Classification of Diseases (ICD)‐9 codes, the American Medical Association Common Procedure Terminology (CPT) codes, and the health care common procedures codes (HCPCS) (Table ) …”