Pancreatic Adenocarcinoma in New Mexico Native Americans: Disparities in Treatment and Survival

Greenbaum, Alissa; Alkhalili, Eyas; Rodriguez, Rodrigo; O'Neill, Jacqueline; Munoz, Oscar Estrada; Qeadan, Fares; Myers, Orrin; Nir, Itzhak; Morris, Katherine T.

doi:10.1353/hpu.2019.0045

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…272 A small study of diverse individuals in New Mexico suggested that patients who self-identified as 'Native American' (most likely Navajo) had a higher mortality risk within 30 days of diagnosis, poorer 5-year survival and were less likely to receive chemotherapy than NHWs and Hispanics/Latinos. 276 Potential aetiological factors Behavioural and lifestyle factors that are related to pancreatic cancer risk and prognosis, including smoking, diabetes, obesity and alcohol consumption, have been suggested to play a role in the observed disparities in incidence and mortality, especially among AA/Bs. 89,270 In particular, sudden-onset diabetes has been reported to increase the risk of pancreatic cancer among AA/Bs and Latinos.…”

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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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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“…Prior studies have shown that race is an independent predictor of a late diagnosis of PC and poor survival in all stages (20)(21)(22)(23)(24). In these studies, the survival differences by race were driven largely by differences in surgery and treatment rates in early stage or potentially curative disease settings (3,4,12,25).…”

Section: Discussionmentioning

confidence: 99%

Association of social determinants of health with late diagnosis and survival of patients with pancreatic cancer

Fabregas¹,

Riley²,

Brant³

et al. 2022

J Gastrointest Oncol

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Background: Pancreatic cancer disparities have been described. However, it is unknown if they contribute to a late diagnosis and survival of patients with metastatic disease. Identifying their role is important as it will open the door for interventions. We hypothesize that social determinants of health (SDH) such as income, education, race, and insurance status impact (I) stage of diagnosis of PC (Stage IV vs. other stages), and (II) overall survival (OS) in Stage IV patients. Methods: Using the National Cancer Database, we evaluated a primary outcome of diagnosis of Stage IV PC and a secondary outcome of OS. Primary predictors included race, income, education, and insurance. Covariates included age, sex and Charlson-Deyo comorbidity score. Univariate, multivariable logistic regression models evaluated risk of a late diagnosis. Univariate, multivariable Cox proportional hazards model examined OS. 95% confidence intervals were used.Results: 230,877 patients were included, median age of 68 years (SD 12.1). In univariate analysis, a better education, higher income, and insurance decreased the odds of Stage IV PC, while Black race increased it.In multivariable analysis, education [>93% high-school completion (HSC) vs. <82.4%, OR 0.96 (0.93-0.99)] and insurance [private vs. no, OR 0.72 (0.67-0.74)] significantly decreased the risk of a late diagnosis, whereas Black race increased the odds [vs. White, OR 1.09 (1.07-1.12)]. In univariate Cox analysis, having a higher income, insurance and better education improved OS, while Black race worsened it. In multivariable Cox, higher income [>$63,333 (vs. <$40,277), HR 0.87 (0.85-0.89)] and insurance [private vs. no, HR 0.77 (0.74-0.79)] improved OS.Conclusions: SDH impacted the continuum of care for patients with advanced pancreatic cancer, including stage at diagnosis and overall survival.

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“…Similarly to patients with resectable disease, both diagnosis and treatment of metastatic PDAC at a high‐volume hospital are associated with improved survival 34 . However, even in states with an NCI Comprehensive Cancer Center, such as New Mexico, NA/AN patients had less than one‐half the likelihood of receiving or being offered chemotherapy and were more likely to die at 1 month (25.8% vs 7.5%) and at 1 year (26.2% vs 48.3%) after diagnosis 35 . To our knowledge, no data exist on palliative chemotherapy disparities in other states with substantial NA/AN populations but without NCI Comprehensive Cancer Centers.…”

Section: The Ideal and Reality: Referral Treatment And Outcomes In Na...mentioning

confidence: 99%

Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs

First

Sutton

Shannon

et al. 2022

Cancer

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Disparities in pancreatic cancer incidence and outcomes exist in Native American populations. These disparities are multifactorial, difficult to quantify, and are influenced by historical, socioeconomic, and health care structural factors. The objective of this article was to assess these factors and offer a call to action to overcome them. The authors reviewed published data on pancreatic cancer in Native American populations with a focus on disparities in incidence, outcomes, and research efforts. The historical context of the interactions between Native Americans and the United States health care system was also analyzed to form actionable items to build trust and collaboration. The incidence of pancreatic cancer in Native Americans is higher than that in the general US population and has the worst survival of any major racial or ethnic group. These outcomes are influenced by a patient population with often poor access to high‐quality cancer care, historical trauma potentially leading to reduced care utilization, and a lack of research focused on etiologies and comorbid conditions that contribute to these disparities. A collaborative effort between nontribal and tribal leaders and cancer centers is key to addressing disparities in pancreatic cancer outcomes and research. More population‐level studies are needed to better understand the incidence, etiologies, and comorbid conditions of pancreatic cancer in Native Americans. Finally, a concerted, focused effort should be undertaken between nontribal and tribal entities to increase the access of Native Americans to high‐quality care for pancreatic cancer and other lethal malignancies.

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Pancreatic Adenocarcinoma in New Mexico Native Americans: Disparities in Treatment and Survival

Cited by 5 publications

References 12 publications

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

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

Association of social determinants of health with late diagnosis and survival of patients with pancreatic cancer

Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs

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