Impact of Race, Insurance Status, and Primary Language on Presentation, Treatment, and Outcomes of Patients with Pancreatic Adenocarcinoma at a Safety-Net Hospital

Sridhar, Praveen; Misir, Priya; Kwak, Hyunjee V.; deGeus, Susanna W.; Drake, Frederick Thurston; Cassidy, Michael R.; McAneny, David; Tseng, Jennifer F.; Sachs, Teviah E.

doi:10.1016/j.jamcollsurg.2019.05.027

Cited by 25 publications

(31 citation statements)

References 26 publications

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“…After title and abstract review, 70 manuscripts were identified for full-text review. After full-text review, 29 studies met the inclusion criteria (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

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Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

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ImportanceEnglish language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of language barriers with perioperative care and surgical outcomes to inform efforts aimed at reducing health care disparities.ObjectiveTo examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes.Evidence ReviewA systematic review was conducted in MEDLINE, Embase, Web of Science, Sociological Abstracts, and CINAHL of all English-language publications from database inception to December 7, 2022. Searches included Medical Subject Headings terms related to language barriers, perioperative or surgical care, and perioperative outcomes. Studies that investigated adults in perioperative settings and involved quantitative data comparing cohorts with limited English proficiency and English proficiency were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Because of heterogeneity in analysis and reported outcomes, data were not pooled for quantitative analysis. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline.FindingsOf 2230 unique records identified, 29 were eligible for inclusion (281 266 total patients; mean [SD] age, 57.2 [10.0] years; 121 772 [43.3%] male and 159 240 [56.6%] female). Included studies were observational cohort studies, except for a single cross-sectional study. Median cohort size was 1763 (IQR, 266-7402), with a median limited English proficiency cohort size of 179 (IQR, 51-671). Six studies explored access to surgery, 4 assessed delays in surgical care, 14 assessed surgical admission length of stay, 4 assessed discharge disposition, 10 assessed mortality, 5 assessed postoperative complications, 9 assessed unplanned readmissions, 2 assessed pain management, and 3 assessed functional outcomes. Surgical patients with limited English proficiency were more likely to experience reduced access in 4 of 6 studies, delays in obtaining care in 3 of 4 studies, longer surgical admission length of stay in 6 of 14 studies, and more likely discharge to a skilled facility than patients with English proficiency in 3 of 4 studies. Some additional differences in associations were found between patients with limited English proficiency who spoke Spanish vs other languages. Mortality, postoperative complications, and unplanned readmissions had fewer significant associations with English proficiency status.Conclusions and RelevanceIn this systematic review, most of the included studies found associations between English proficiency and multiple perioperative process-of-care outcomes, but fewer associations were seen between English proficiency and clinical outcomes. Because of limitations of the existing research, including study heterogeneity and residual confounding, mediators of the observed associations remain unclear. Standardized reporting and higher-quality studies are needed to understand the impact of language barriers on perioperative health disparities and identify opportunities to reduce related perioperative health care disparities.

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“…After title and abstract review, 70 manuscripts were identified for full-text review. After full-text review, 29 studies met the inclusion criteria (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were observational, and 26 of 29 studies were retrospective. All were cohort studies except for 1 cross-sectional study.…”

Section: Resultsmentioning

confidence: 99%

Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

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“…Literature regarding racial disparities in receipt of neoadjuvant therapy is limited. In one recent study, there was no difference in the use of perioperative therapy by race in patients with pancreatic adenocarcinoma treated at an urban safety‐net hospital 27 . However, another retrospective cohort study utilizing the NCDB found that non‐Hispanic Black and Hispanic patients with PDAC were less likely to receive multi‐modality therapy including chemotherapy, but no difference in receipt of neoadjuvant therapy was observed 17 .…”

Section: Discussionmentioning

confidence: 99%

“…However, postoperative complications are associated with failure to complete adjuvant therapy, which may have a significant impact on long‐term outcomes 24 . Complication rates following complex pancreatic surgery are known to vary based on surgeon and hospital volume, as well as underlying patient factors, including comorbidity and performance status 25–27 . Even in high volume centers, 90‐day morbidity rates of pancreaticoduodenectomy are as high as 35%–50% and mortality 1%–5% 28–30 …”

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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“…34 Our study showed that not only uninsured patients, but even patients with Medicaid insurance were less likely to receive NAT at an NAT facility, which is consistent with prior findings reported in the literature. 35…”

Section: Discussionmentioning

confidence: 99%

Underlying Bias in the Treatment of Pancreatic Cancer

et al. 2023

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Objective: To identify disparities in access to NAT for PDAC at the prehospital and intrahospital phases of care. Summary of Background Data: Delivery of NAT in PDAC is susceptible to disparities in access. There are limited data that accurately locate the etiology of disparities at the prehospital and intrahospital phases of care. Methods: Retrospective cohort of patients ≥18 years old with clinical stage I-II PDAC from the 2010–2016 National Cancer Database. Multiple logistic regression was used to assess 2 sequential outcomes: (1) access to an NAT facility (prehospital phase) and (2) receipt of NAT at an NAT facility (intrahospital phase). Results: A total of 36,208 patients were included for analysis in the prehospital phase of care. Higher education, longer travel distances, being treated at academic/research or integrated network cancer programs, and more recent year of diagnosis were independently associated with receipt of treatment at an NAT facility. All patients treated at NAT facilities (31,099) were included for the second analysis. Higher education level and receiving care at an academic/research facility were independently associated with increased receipt of NAT. NonBlack racial minorities (including American Indian, Asian, Pacific Islanders), being Hispanic, being uninsured, and having Medicaid insurance were associated with decreased receipt of NAT at NAT facilities. Conclusions: Non-Black racial minorities and Hispanic patients were less likely to receive NAT at NAT facilities compared to White and non-Hispanic patients, respectively. Discrepancies in administration of NAT while being treated at NAT facilities exist and warrant urgent further investigation.

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Impact of Race, Insurance Status, and Primary Language on Presentation, Treatment, and Outcomes of Patients with Pancreatic Adenocarcinoma at a Safety-Net Hospital

Cited by 25 publications

References 26 publications

Association of Language Barriers With Perioperative and Surgical Outcomes

Association of Language Barriers With Perioperative and Surgical Outcomes

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

Underlying Bias in the Treatment of Pancreatic Cancer

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