Racial/Ethnic Patterns of Care for Pancreatic Cancer

Abstract

Introduction: The small proportion of cancers diagnosed at the local disease stage, resectable at the time diagnosis, and responsive to chemotherapy contribute to poor survival making pancreatic cancer the fourth leading cause of cancer death among Americans. This emphasizes the importance of receiving appropriate palliative care. Racial=ethnic cancer treatment disparities have been observed for many cancer sites. We examine patterns of care in a population-based sample of African American, Hispanic and non-Hispanic white patients diagnosed with pancreatic cancer. Methods: Eligible cases were age 20 or older and newly diagnosed in 1998 with primary adenocarcinoma of the pancreas reported to the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program and selected for the NCI Patterns of Care=Quality of Care (POC=QOC) project (n ¼ 697). Results: Chemotherapy, the most frequently received treatment was less frequently received by African American patients (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.37-0.95) and radiation less frequently received by Hispanic compared to non-Hispanic white white patients (OR 0.50, 95% CI, 0.27-0.95) after adjustment for age, stage, size of tumor, and insurance status in a multivariate regression model. Cancer-directed surgery of the primary site was received by 14.1% of patients, which did not significantly differ by race= ethnicity. Uninsured patients less often were recommended for or received surgery (OR 0.09, 95% CI 0.01-0.62) and (OR 0.07, 95% CI, 0.01-0.49), respectively. Conclusion: Differences in primary tumor size, stage and insurance status contributed to racial=ethnic differences in the receipt of cancer-directed surgery but did not explain differences in the receipt of chemotherapy for African American or radiation for Hispanic patients. More population-based research is needed to examine race=ethnicity, insurance status and receipt of treatment and palliative care for pancreatic cancer.

Racial disparities in treatment for pancreatic cancer and impact on survival: a population-based analysis

“…Our data clearly show that only 19% of blacks and 14.5% Hispanics received radiation treatment compared to 22% whites and 25% Asians. These data are in agreement with a previously reported study in which radiation was received by only 15.5 and 16.4% of Hispanics and blacks, respectively (Shavers et al 2009). Previous studies have shown that when the data are controlled for receiving resection for cancer, the outcome is similar and is irrespective of the patient's race (Murphy et al 2009).…”

“…These Wndings are similar to SEER-based study including cases from 1998 (Shavers et al 2009). Overall, the cancer was more common in women with the proportion of women being higher for blacks and Hispanics.…”

“…In another study, blacks represented about 25% of cases (Shavers et al 2009). However, this study incorporated pancreatic adenocarcinoma cases from the SEER database only from the year 1998.…”

“…Reasons for diVerences in survival amongst various races have been linked to obesity, smoking, radon exposure, and tumour details such as size and stage (Arnold et al 2009;Reddy and Bhutani 2009;Shavers et al 2009). Studies have shown that blacks receive resection less often compared to whites (Murphy et al 2009;Riall et al 2010).…”

How Do Differences in Treatment Impact Racial and Ethnic Disparities in Acute Myeloid Leukemia?

“…Appropriate treatment is known to be one of the most important predictors of survival in AML (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Differences in receipt of appropriate or evidence-based treatment by race and ethnicity correlate with worse outcomes from several solid malignancies (12,17,18).…”