Differences in receipt of multimodality therapy by race, insurance status, and socioeconomic disadvantage in patients with resected pancreatic cancer

Abstract

Background and Methods: Racial and socioeconomic disparities in receipt of adjuvant chemotherapy affect patients with pancreatic cancer. However, differences in receipt of neoadjuvant chemotherapy among patients undergoing resection are not well-understood. A retrospective cross-sectional cohort of patients with resected AJCC Stage I/II pancreatic ductal adenocarcinoma was identified from the National Cancer Database (2014)(2015)(2016)(2017). Outcomes included receipt of neoadjuvant versus adjuvant chemotherapy, or receipt of either, defined as multimodality therapy and were assessed by univariate and multivariate analysis.Results: Of 19 588 patients, 5098 (26%) received neoadjuvant chemotherapy, 9624 (49.1%) received adjuvant chemotherapy only, and 4757 (24.3%) received no chemotherapy. On multivariable analysis, Black patients had lower odds of neoadjuvant chemotherapy compared to White patients (OR: 0.80, 95% CI: 0.67-0.97) but no differences in receipt of multimodality therapy (OR: 0.89, 95% CI: 0.77-1.03). Patients with Medicaid or no insurance, low educational attainment, or low median income had significantly lower odds of receiving neoadjuvant chemotherapy or multimodality therapy.Conclusions: Racial and socioeconomic disparities persist in receipt of neoadjuvant and multimodality therapy in patients with resected pancreatic adenocarcinoma.Discussion: Policy and interventional implementations are needed to bridge the continued socioeconomic and racial disparity gap in pancreatic cancer care.

Treatment acceptance and its associated determinants in cancer patients: A systematic review

“…Low acceptance of multimodality therapy related to socio-economic factors including the insurance availability, range to the health facilities nearby, geographical factors, low level of education and income [ 3 ]. Older age, presence of comorbidities, and pessimistic personality are also barriers to acceptance of therapy.…”

“…Increased number of morbidities, mortality and recurrence leads to increased length of treatment and costs which results in lower quality of life. Several factors influence patient adherence in carrying out therapy such as sociodemographic, economic, and spiritual-cultural; patient knowledge and perceptions; perception and support from people around the patient; as well as policy and availability of health facilities [ 3 , 4 ].…”

Pancreatic Cancer Health Disparity: Pharmacologic Anthropology

“…Pharmacologic anthropology investigates the barriers that limit access to appropriate healthcare services for PCa patients. It examines disparities in healthcare infrastructure, insurance coverage, geographic location, and healthcare provider bias, which can affect timely diagnosis, treatment initiation, and overall quality of care [20][21][22][23][24][25][26]. While pharmacologic anthropology primarily focuses on the social and cultural dimensions of health disparities, it also recognizes the importance of genetic and biological factors in PCa.…”

Socio‐demographic index and socioeconomic classes for understanding the divisible differences in receiving multimodal therapy in patients with pancreatic cancers

“…Socio-demographic index and socioeconomic classes for understanding the divisible differences in receiving multimodal therapy in patients with pancreatic cancers Dear Editor, It is with great interest that we have read the article by Hao, Scarlett et al 1 regarding the differences in receipt of multimodality therapy by race, insurance status, and socioeconomic disadvantage in patients with resected pancreatic cancer, recently published in the Journal of Surgical Oncology. While keeping the parameters of the study in mind, we would like to further discuss a global and regional indicator for use in future studies which has a multidimensional role in explaining the differences in receiving multimodal therapy in cancer patients.…”

“…Figure 1 elaborates upon a clear differentiation of various indices, such as death rates, incidences, and prevalence of pancreatic cancer amongst low SDI, middle SDI, highmiddle SDI, low-middle SDI, and high SDI groups based on the Global Health Data Exchange (GHDx). 2,3 In the study by Hao et al, 1 patients were subdivided by race/ethnicity cohorts defined by the prespecified categories: non-Hispanic White, non-Hispanic Black, Hispanic, and Other. However, on a global scale, we would like to extrapolate and express that these discrepancies not only lie within the groups of races but also on global, national, and regional levels.…”