Disparities in the Use of Chemotherapy in Patients with Resected Pancreatic Ductal Adenocarcinoma

Wright, Michael J.; Overton, Heidi N.; Teinor, Jonathan A.; Ding, Ding; Burkhart, Richard A.; Cameron, John L.; He, Jin; Wolfgang, Christopher L.; Weiss, Matthew J.; Javed, Ammar A.

doi:10.1007/s11605-019-04311-z

Cited by 22 publications

(18 citation statements)

References 31 publications

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“…The existence of racial and socioeconomic disparities among patients receiving cancer surgery care at CoC hospitals in the United States has been previously documented 30 . In particular, data have suggested racial disparities both in the utilization of surgical resection for patients with early‐stage pancreatic cancer, as well as receipt of chemotherapy 31,32 . Similarly, Mehta et al 33 has previously reported insurance status differences among patients undergoing hepato‐pancreatic surgery, with Medicaid patients being less likely to receive care at academic urban teaching hospitals.…”

Section: Discussionmentioning

confidence: 97%

Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma

Sweigert

Eguia

Baker

et al. 2020

Journal of Surgical Oncology

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Background Composite outcomes may more accurately reflect patient and provider expectations around optimal care. We sought to determine the impact of achieving a so‐called “textbook oncologic outcome” (TOO) among patients undergoing resection of pancreatic adenocarcinoma (PDAC). Methods Patients undergoing pancreaticoduodenectomy (PD) for PDAC between 2006 and 2016 were identified in the National Cancer Database (NCDB). TOO was defined by: margin negative resection, compliant lymph node evaluation, no prolonged length‐of‐stay, no 30‐day readmission/mortality, and receipt of adjuvant chemotherapy. Factors associated with TOO and overall survival (OS) were evaluated using multivariable logistic and Cox regression models, respectively. Results Among 18 608 patients who underwent PD at 782 hospitals, many patients successfully achieved certain TOO factors such as R0 margin (77.9%) and no 30‐day mortality (96.9%), while other TOO criteria such as receipt of adjuvant therapy (48.2%) were achieved less frequently. Overall, only 3124 (16.8%) patients achieved a TOO. Factors associated with lower odds of TOO included: older age, Black race, Medicaid insurance, Community facility, and low PD facility (<20 PD/y) (all P < .05). Achievement of a TOO was associated with lower risk of mortality (HR 0.74; 95% CI, 0.70‐0.77). Conclusions While TOO was associated with improved long‐term survival, TOO was only achieved in 16.8% of patients undergoing PD.

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Section: Discussionmentioning

confidence: 97%

Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma

Sweigert

Eguia

Baker

et al. 2020

Journal of Surgical Oncology

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“…Healthcare and treatment Differences in diagnosis and treatment have been shown to contribute to some of the observed disparities in survival by race/ethnicity, especially for AA/Bs. 89,270,281,282 Factors such as older age, minority race/ethnicity, lower SES, being uninsured or on Medicaid, higher comorbidity index and treatment at a nonacademic centre or a low-volume hospital have been inversely correlated with receiving standard therapy including surgery, 281,[283][284][285][286][287][288] and are also associated with patient refusal of treatment. 275,289 A study conducted within the Kaiser Southern California patient population (an integrated system), reported no racial/ethnic differences with regard to pancreatic cancer treatment and outcomes.…”

Section: Disparities In Pancreatic Cancermentioning

confidence: 99%

Cancer health disparities in racial/ethnic minorities in the United States

et al. 2020

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There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA—African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.

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“…In a study of 645 patients with pancreatic cancer by Saif et al 25 no significant differences between Black and White patients were noted with respect to receipt of multi‐modality therapy. Finally, in the locally advanced and metastatic setting, two SEER‐Medicare studies concluded that Black patients with PDAC were less likely to receive adjuvant chemotherapy or palliative chemotherapy 10,11 …”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have also demonstrated that Black patients with pancreatic cancer are less likely to undergo surgical resection regardless of cancer stage, especially when presenting to low‐volume, non‐National Cancer Institute/National Comprehensive Cancer Network‐designated cancer care hospitals. In addition, Black patients are less likely to receive perioperative multimodality therapy 8–20 …”

Section: Introductionmentioning

confidence: 99%

Thirty‐day complication rates do not differ by race among patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

Mitsakos

Dennis

Parikh

et al. 2021

Journal of Surgical Oncology

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Background and Objectives Black patients with pancreatic ductal adenocarcinoma (PDAC) are less likely to receive multimodality treatment and have worse survival compared to White patients. However, little is known regarding racial differences in postoperative outcomes. The primary aim of this study was to determine if 30‐day complication rates following pancreaticoduodenectomy (PD) differ by race. Methods A retrospective cohort study of patients who underwent PD for PDAC from 2014 to 2016 within the ACS‐NSQIP pancreatectomy‐specific data set was performed. Primary outcomes were 30‐day pancreas‐specific and overall major complications. Results A total of 6936 patients were identified, including 91.4% (N = 6337) White and 8.6% (N = 599) Black. Pathologic stage and rates of neoadjuvant therapy were similar among Whites and Blacks. Rates of pancreas‐specific (23.9% vs. 23.1%, p = .88) and major postoperative complications (39.2% vs. 39.9%, p = .55) were similar between Whites and Blacks. By multivariable regression analysis, there was no association between race and odds of pancreas‐specific complications (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.89–1.37) or overall major complications (OR 1.13, 95% CI 0.95–1.36). Conclusions Among patients undergoing PD for PDAC, Black race is not associated with increased pancreas‐specific or overall 30‐day postoperative complications. Short‐term postoperative outcomes do not appear to explain the increase in pancreatic cancer mortality among Black patients.

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Disparities in the Use of Chemotherapy in Patients with Resected Pancreatic Ductal Adenocarcinoma

Cited by 22 publications

References 31 publications

Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma

Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma

Cancer health disparities in racial/ethnic minorities in the United States

Thirty‐day complication rates do not differ by race among patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

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