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

Thobie, Alexandre; Mulliri, Andréa; Bouvier, Véronique; Launoy, Guy; Alvès, Arnaud; Dejardin, Olivier

doi:10.1089/heq.2019.0099

Cited by 10 publications

(5 citation statements)

References 46 publications

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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). However, our analyses were instead focused on those with metastatic disease, eliminating the administration of curative intent treatments as mediators.…”

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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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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“…Most of the studies examining the impact of SES have come from United States wherein inability to access healthcare care has been attributed to a lack of insurance among LSES patients. 11 However, the phenomenon of differential access to care was evident even in studies from Europe with a universal health care system, which prompts the need for reflection on what other modifiable factors may be influencing outcomes in the guise of SES. This warrants a more granular approach, beyond healthcare budgets and insurance.…”

Section: Discussionmentioning

confidence: 99%

“…LSES patients seem to have a significantly lower probability of undergoing surgery for resectable pancreatic cancer ( P < 0.01). The factors responsible for this could be manifold including reduced financial capacity, inequalities in insurance coverage, 11 geographical disparities linked to distance, increased likelihood of significant co‐morbidities, 33 poor patient education levels 11 and disease perceptions, 34 social support systems including informal caregiver burden, and the reduced likelihood of being offered surgery 35 . A cross‐sectional study from China reported that among all treatment modalities for breast cancer, surgery most commonly resulted in Catastrophic Health Expenditure , defined as the point at which annual household health payments exceeded 40% of non‐food household costs 36 .…”

Section: Discussionmentioning

confidence: 99%

“…Fonseca et al 10 summarized disparities in access to oncological care in pancreatic cancer, in general. Thobie et al 11 have previously reviewed the literature in pancreatic cancer and reported that patients from the LSES are less likely to undergo any surgery for pancreatic cancer compared to those with high SES (HSES). The role of SES on other forms of therapy in resectable pancreatic cancer, as well as overall survival were not analysed.…”

Section: Introductionmentioning

confidence: 99%

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The influence of socioeconomic status on access to cancer care and survival in resectable pancreatic cancer: a systematic review and meta‐analysis

Petric

Handshin

Jonnada

et al. 2022

ANZ Journal of Surgery

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Background: Socioeconomic status (SES) is an important factor affecting access to cancer care and survival. Its role in pancreatic cancer warrants scrutiny. Methods: A systematic review of major reference databases was undertaken. Categorization of the study population into low SES (LSES) and high SES (HSES) was based on the criteria employed in the individual studies. The outcome measures studied were stage of cancer presentation, access to care and overall survival. Meta-analysis was performed using random-effects models and trial sequential analysis (TSA) was used to assess the precision and conclusiveness of the results. Results: Thirteen studies meeting inclusion criteria were included in the meta-analysis, which demonstrated that LSES was associated with significantly lower rates of presentation at a nonmetastatic stage and poorer access to cancer care, viz. surgery, chemotherapy and radiation therapy. Despite heterogeneity, TSA supported the findings, displaying minimal type I error. Conclusion: As LSES is associated with delayed presentation, poorer access to care and poorer survival, SES should be considered a modifiable risk factor for poor outcomes in pancreatic cancer.

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“…Exercise during treatment is crucial for the optimization of the quality of life; however, well-designed trials are required (64). The low socio-economic status of patients in Europe and North America is associated with a reduced access to surgery or an increased likelihood of refusing surgery, which is influenced by a low income, poor levels of education, insurance coverage and rural areas (65).…”

Section: Introductionmentioning

confidence: 99%

A pancreatic adenocarcinoma mimicking hepatoid carcinoma of uncertain histogenesis: A case report and literature review

Iliesiu,

Toma,

Ciongariu

et al. 2023

Oncol Lett

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In rare cases, metastatic adenocarcinomas of different origin may exhibit the features of hepatoid carcinoma (HC), a rare malignant epithelial tumor, most commonly occurring in the ovaries and stomach, as well as in the pancreas and biliary ducts. A case of a 72-year-old female patient who developed a highly aggressive, poorly differentiated pancreatic ductal adenocarcinoma with peritoneal carcinomatosis, demonstrating hepatoid differentiation upon conventional hematoxylin and eosin staining is reported in the present study. The patient presented with severe abdominal pain, and the radiological investigations performed revealed ovarian and hepatic tumor masses and peritoneal lesions, which were surgically removed. The gross examination of the peritoneum and omentum revealed multiple solid, firm, grey-white nodules, diffusely infiltrating the adipose tissue. The microscopic examination revealed a malignant epithelial proliferation, composed of polygonal cells with abundant eosinophilic cytoplasm and irregular, pleomorphic nuclei. Certain cells presented with intracytoplasmic mucus inclusions, raising suspicion of a HC with an uncertain histogenesis. Immunohistochemical staining was performed, and the tumor cells were found to be positive for cytokeratin (CK)7, CK18 and mucin 5AC, whereas negative staining for CK20, caudal-type homeobox transcription factor 2, α-fetoprotein, paired box gene 8, GATA-binding protein 3 and Wilms tumor 1 were documented. Thus, the diagnosis of metastatic pancreatic adenocarcinoma was established. The main aim of the present study was to provide further knowledge concerning poorly differentiated metastatic adenocarcinoma resembling HC, emphasizing the histopathological and immunohistochemical features of these malignant lesions and raising awareness of the diagnostic difficulties that may arise, as well as the importance of the use immunohistochemistry in differentiating carcinomas of uncertain histogenesis.

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

Cited by 10 publications

References 46 publications

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

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

The influence of socioeconomic status on access to cancer care and survival in resectable pancreatic cancer: a systematic review and meta‐analysis

A pancreatic adenocarcinoma mimicking hepatoid carcinoma of uncertain histogenesis: A case report and literature review

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