Skip to main content

Advertisement

SpringerLink
Log in

Disparities in Pancreas Cancer Care

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fast Stats: An interactive tool for access to SEER cancer statistics. Surveillance Research Program, National Cancer Institute. http://seer.cancer.gov/faststats. Accessed 20 Dec 2010.

  2. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5): 277–300.

    Article  PubMed  Google Scholar 

  3. Baxter NN, Whitson BA, Tuttle TM. Trends in the treatment and outcome of pancreatic cancer in the United States. Ann Surg Oncol. 2007;14(4): 1320–6.

    Article  PubMed  Google Scholar 

  4. DeLancey JOL, Thun MJ, Jemal A, Ward EM. Recent trends in black-white disparities in cancer mortality. Cancer Epidemiol Biomark Prev. 2008;17(11): 2908–12.

    Article  PubMed  Google Scholar 

  5. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS. National failure to operate on early stage pancreatic cancer. Ann Surg. 2007;246(2): 173–80.

    Article  PubMed  Google Scholar 

  6. Cress RD, Yin DX, Clarke L, Bold R, Holly EA. Survival among patients with adenocarcinoma of the pancreas: A population-based study (United States). Cancer Causes Control. 2006;17(4): 403–09.

    Article  PubMed  Google Scholar 

  7. Riall T, Townsend CJ, Kuo Y, Freeman J, Goodwin J. Dissecting racial disparities in the treatment of patients with locoregional pancreatic cancer: a 2-step process. Cancer. 2010;116(4): 930–9.

    Article  PubMed  Google Scholar 

  8. Lucas F, Stukel T, Morris A, Siewers A, Birkmeyer J. Race and surgical mortality in the United States. Ann Surg. 2006;243(2): 281–6.

    Article  PubMed  CAS  Google Scholar 

  9. Cheung M, Yang R, Byrne M, Solorzano C, Nakeeb A, Koniaris L. Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma?. Cancer. 2010;116(3): 723–33.

    Article  PubMed  Google Scholar 

  10. Krzyzanowska M, Weeks J, Earle C. Treatment of locally advanced pancreatic cancer in the real world: population-based practices and effectiveness. J Clin Oncol. 2003;21(18): 3409–14.

    Article  PubMed  Google Scholar 

  11. Eloubeidi MA, Desmond RA, Wilcox CM, et al. Prognostic factors for survival in pancreatic cancer: a population-based study. Am J Surg. 2006;192(3): 322–29.

    Article  PubMed  Google Scholar 

  12. Shavers VL, Harlan LC, Jackson M, Robinson J. Racial/ethnic patterns of care for pancreatic cancer. J Palliative Med. 2009;12(7): 623–30.

    Article  Google Scholar 

  13. Murphy MM, Simons JP, Hill JS, et al. Pancreatic resection a key component to reducing racial disparities in pancreatic adenocarcinoma. Cancer. 2009;115(17): 3979–90.

    Article  PubMed  Google Scholar 

  14. Arnold L, Patel A, Yan Y, et al. Are racial disparities in pancreatic cancer explained by smoking and overweight/obesity?. Cancer Epidemiol Biomark Prev. 2009;18(9): 2397–405.

    Article  PubMed  Google Scholar 

  15. Chang D, Zhang Y, Mukherjee D, et al. Variations in referral patterns to high-volume centers for pancreatic cancer. J Am Coll Surg. 2009;209(6): 720–6.

    Article  PubMed  Google Scholar 

  16. Riall T, Eschbach K, Townsend CJ, Nealon W, Freeman J, Goodwin J. Trends and disparities in regionalization of pancreatic resection. J Gastrointest Surg. 2007;11(10): 1242–51; discussion 51-2.

    Google Scholar 

  17. Epstein A, Gray B, Schlesinger M. Racial and ethnic differences in the use of high-volume hospitals and surgeons. Arch Surg. 2010;145(2): 179–86.

    Article  PubMed  Google Scholar 

  18. Liu J, Zingmond D, McGory M, et al. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA. 2006;296(16): 1973–80.

    Article  PubMed  CAS  Google Scholar 

  19. Murphy M, Simons J, Ng S, et al. Racial differences in cancer specialist consultation, treatment, and outcomes for locoregional pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16(11): 2968–77.

    Article  PubMed  Google Scholar 

  20. Zell J, Rhee J, Ziogas A, Lipkin S, Anton-Culver H. Race, socioeconomic status, treatment, and survival time among pancreatic cancer cases in California. Cancer Epidemiol Biomark. Prev 2007;16(3): 546–52.

    Article  PubMed  Google Scholar 

  21. Komenaka IK, Martinez ME, Pennington RE, et al. Race and ethnicity and breast cancer outcomes in an underinsured population. J Natl Cancer Inst. 2010;102(15): 1178–87.

    Article  PubMed  Google Scholar 

  22. Kuhn Y, Koscielny A, Glowka T, Hirner A, Kalff J, Standop J. Postresection survival outcomes of pancreatic cancer according to demographic factors and socio-economic status. Eur J Surg Oncol. 2010;36(5): 496–500.

    Article  PubMed  CAS  Google Scholar 

  23. Mulligan CR, Meram AD, Proctor CD, Wu H, Zhu K, Marrogi AJ. Unlimited access to care: effect on racial disparity and prognostic factors in lung cancer. Cancer Epidemiol Biomark Prev. 2006;15(1): 25–31.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by Enhancing Minority Participation in Clinical Trials (Empact), National Institute on Minority Health and Health Disparities. Project Number: 5RC2MD004797-02. Recipient of the 2011 American Society of Clinical Oncology Foundation Merit Award and 2011 Pancreas Club meeting Poster of Note.

Author information

Authors and Affiliations

  1. The Minnesota Surgical Outcomes Workgroup, University of Minnesota Surgical Outcomes Research Center, University of Minnesota, Minneapolis, MN, USA

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

  2. Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Waddah B. Al-Refaie

  3. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Elizabeth B. Habermann

Authors
  1. Anasooya Abraham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Waddah B. Al-Refaie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Helen M. Parsons
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vikas Dudeja
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Selwyn M. Vickers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elizabeth B. Habermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth B. Habermann.

Appendices

Appendix 1

Continuum of pancreas cancer care

Appendix 2

See Table 10.

Table 10 Demographic and tumor characteristics of total cohort (N = 20,312)
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abraham, A., Al-Refaie, W.B., Parsons, H.M. et al. Disparities in Pancreas Cancer Care. Ann Surg Oncol 20, 2078–2087 (2013). https://doi.org/10.1245/s10434-012-2843-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2843-z

Keywords

Search

Navigation