Disparities in pancreas cancer care

Anasooya Abraham, Waddah B. Al-Refaie, Helen M. Parsons, Vikas Dudeja, Selwyn M. Vickers, Elizabeth B. Habermann

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

Background: Prior literature shows demographic differences in patients surgically treated for pancreatic cancer (PC). We hypothesized that socioeconomic disparities also exist across all aspects of PC care, in both surgically and non-surgically treated patients. Methods: We identified a cohort of patients with American Joint Committee on Cancer (AJCC) stage I-IV PC in the 1994-2008 California Cancer Registry. We used multivariate logistic regression to examine the impact of race, sex, and insurance status on (1) resectability (absence of advanced disease), (2) receipt of surgery, and (3) receipt of adjuvant/primary chemotherapy (+/- radiotherapy). Results: Among 20,312 patients, 7,585 (37 %) had resectable disease; 40 % who met this definition received surgery (N = 3,153). On multivariate analysis, males were less likely to present with resectable tumors [odds ratio (OR) 0.91, 95 % confidence interval (CI) 0.85-0.96], but sex did not otherwise predict treatment. Black patients were as likely as White patients to show resectable disease, yet were less likely to receive surgery (OR 0.66, 95 % CI 0.54-0.80), and adjuvant (OR 0.75, 95 % CI 0.58-0.98) or primary chemotherapy +/- radiation. Compared with Medicaid recipients, non-Medicare/Medicaid enrollees were more likely to receive surgery (OR 1.7, 95 % CI 1.4-2.2), and the uninsured were less likely to receive adjuvant therapy (OR 0.54, 95 % CI 0.30-0.98). Conclusions: Though Black patients appear to present with comparable rates of resectability, they receive care that deviates from current guidelines. Insurance status is associated with inferior profiles of resectability and treatments. Future policies and research should identify effective strategies to ensure receipt of standard care.

Original languageEnglish (US)
Pages (from-to)2078-2087
Number of pages10
JournalAnnals of Surgical Oncology
Volume20
Issue number6
DOIs
StatePublished - Jun 1 2013

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    Abraham, A., Al-Refaie, W. B., Parsons, H. M., Dudeja, V., Vickers, S. M., & Habermann, E. B. (2013). Disparities in pancreas cancer care. Annals of Surgical Oncology, 20(6), 2078-2087. https://doi.org/10.1245/s10434-012-2843-z