Effect of Socioeconomic Status on Surgery for Pancreatic Adenocarcinoma

Abstract

Survival for pancreatic cancer remains poor. Surgical resection remains the only chance for cure. The intent of this study was to investigate the role of socioeconomic status (SES) on resection rates for pancreatic adenocarcinoma. The National Cancer Institute's Surveillance, Epidemiology, and End results database was used to identify patients with pancreatic adenocarcinoma. Disease was deemed resectable or unresectable based on the extent of disease code. Median family income was used as a SES variable to compare patients who underwent resection with those who did not. Median family income was organized into three categories based on definitions from the national census: less than $34,680 (low income), $34,680 to $48,650 (middle), and greater than $48,650 (high income). A total of 5,908 patients with potentially resectable disease were included. A total of 3,331 patients did not have a surgical resection despite having resectable disease. Subgroup analysis of income status revealed that patients with a low or middle income were less likely to have a resection when compared with those with high income (33.0 vs 39.9 vs 45.8%, P = 0.0001). Multivariate analysis revealed that low and middle SES and race were significant predictors of resection. Ongoing study of access to health care may help define the means to eliminate the disparities in the care of patients with pancreatic adenocarcinoma.

Disparities in Pancreatic Cancer Treatment and Outcomes

“…A group from Harbor-UCLA Medical Center used the SEER database to determine if median family income correlated with surgical resection. 24 Seventy-one (33%) patients were resected in the low-income group in comparison to 679 (39.9%) in the middle income and 1827 (45.8%) in the high-income group. In addition, univariate analysis revealed a statistically significant difference in resection between patients in the low- and middle-income groups compared to high income ( p =0.0001).…”

Socioeconomic Predictors of Pituitary Surgery

“…Given the multitude of factors that influence socioeconomic status, various elements may contribute to disparities seen in receiving treatment. Access to surgery may be influenced in part by financial determinants such as household income, insurance status, and regional coverage, which have been shown to impact access to surgical treatment for various cancer types [ 19 - 21 ]. Moreover, geographic characteristics, such as hospital volume and local referral patterns, may influence treatment selection by influencing both physical access to care as well as the quality of care.…”

Same Chance of Accessing Resection? Impact of Socioeconomic Status on Resection Rates Among Patients with Pancreatic Adenocarcinoma—A Systematic Review

“…Studies have been essentially led on U.S. registries. Low income, 15,21,28 low levels of education, 15 not being insured, 11,[15][16][17]29 and living in deprived and rural areas 21,[24][25][26][27] have all been associated with decreased rates of surgical resection. People from low socioeconomic groups are therefore less likely to receive surgery than those from higher classes.…”

“… 17 Others studies found that patients in the lowest socioeconomic groups are more likely to present with a tumor >5 cm or with more advanced diseases. 12 , 28 On the contrary, it has been found that patients with low SES had slightly more local disease, less disease beyond the pancreas, and a lower stage than those with high SES. 23 , 24 , 26 Resectability for PA is different from TNM staging as defined by UJCC classification.…”