Postresection survival outcomes of pancreatic cancer according to demographic factors and socio-economic status

Abstract

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ARTICLE IN PRESS M A N U S C R I P T A C C E P T E D ARTICLE IN PRESS Kuhn et al. 2 Abstract AIM:Aim of the study was to evaluate the impact of demographic factors (DGF) and socioeconomic status (SES) on survival after pancreatic cancer resection in a German setting. METHODS:Patients with pancreatic adenocarcinoma and pancreaticoduodenectomy were identified from our pancreatic resection database (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). DGF, SES, survival and tumor-related information were obtained from hospital records, a registry office questionnaire, and telephone interviews with patients, relatives and general practitioners. RESULTS:Follow-up was completed in 117 patients. Median overall survival and 5-year survival rate was 22 month and 10%, respectively. Survival significantly improved over time with a 16% 5-year survival and a median survival of 27 month for recent patients. The longest survival period with a median of 63 month was observed for patients with AJCC stage I. Tumorrelated factors and treatment period, but not SES influenced survival after pancreatic cancer resection in our cohort. CONCLUSIONS:To our knowledge, this is the first study to explore survival from pancreatic cancer according to DGF and SES in a German setting. Disparities in survival among our patients depend solely on tumor-related factors and treatment period and could not be explained by SES including key factors like income or type of health insurance. The comparable postresection outcome of patients with low and high SES at our department could be in part due to the universal German multi-payer health system, based on compulsory enrolment for the majority, which seems not to support healthcare inequalities seen in other OECD countries.

The Impact of Socioeconomic Status, Surgical Resection and Type of Hospital on Survival in Patients with Pancreatic Cancer. A Population-Based Study in The Netherlands

“…However, in patients with resectable tumors, SES was no longer a relevant variable for survival. This was also found in a case series of 117 patients in Germany in which the SES was obtained from individual patients[22]. …”

“…These results confirm findings in other studies in which pancreatic cancer patients with lower SES tend to have worse survival and are less likely to receive adequate treatment (Table 4). In the two series reporting on patients who underwent resection the results are contradictory: the Lim paper [21] (n = 396 patients) describes lower survival in the low SES group, whereas in the Kuhn paper [22] (n = 117 patients) no effect was found.…”

The Effect of Socioeconomic Status on Staging and Treatment Decisions in Esophageal Cancer

“…11,28 Pancreatic cancer patients with a low SES had a higher mortality rate in the United States, whereas SES had no effect on pancreatic cancer mortality in Germany. 7,29 Although the observed differences between the United States and Europe are often explained by the absence of a multipayer health care system in the United States, these data suggest that differences in outcome for several cancer types in Europe are most likely also due to decisional factors that are at least partly related to SES.…”

Racial and Social Economic Factors Impact on the Cause Specific Survival of Pancreatic Cancer: A SEER Survey

“…This link has been attributed to an increased distance to major medical centers (Gill and Martin, 2002), and a lack of specialization (van Oost et al, 2006). Other studies have shown a lack of effects from socio-economic factors on pancreas cancer treatment outcome (Kuhn et al, 2010). The Surveillance Epidemiology and End Results (SEER) cancer registry data have been to build prognostic models for pancreatic cancer (Baine et al, 2011;Singal et al, 2012).…”