Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;28(5):2438-2446.
doi: 10.1245/s10434-021-09594-8. Epub 2021 Feb 1.

A Pancreatic Cancer Multidisciplinary Clinic Eliminates Socioeconomic Disparities in Treatment and Improves Survival

Richard S Hoehn  1 , Caroline J Rieser  1 , Sharon Winters  2 , Lauren Stitt  1 , Melissa E Hogg  3 , David L Bartlett  1 , Kenneth K Lee  1 , Alessandro Paniccia  1 , James P Ohr  4 , Vikram C Gorantla  4 , Anuradha Krishnamurthy  4 , John C Rhee  4 , Nathan Bahary  4 , Adam C Olson  5 , Steve Burton  5 , Susannah G Ellsworth  5 , Adam Slivka  6 , Kevin McGrath  6 , Asif Khalid  6 , Kenneth Fasanella  6 , Jennifer Chennat  6 , Randal E Brand  6 , Rohit Das  6 , Ritu Sarkaria  6 , Aatur D Singhi  7 , Herbert J Zeh  8 , Amer H Zureikat  9
Affiliations

A Pancreatic Cancer Multidisciplinary Clinic Eliminates Socioeconomic Disparities in Treatment and Improves Survival

Richard S Hoehn et al. Ann Surg Oncol. 2021 May.

Abstract

Aims: National studies have demonstrated disparities in the treatment and survival of pancreatic cancer patients based on socioeconomic status (SES). This study aimed to identify specific differences in perioperative management and outcomes based on patient SES and to study the role of a multidisciplinary clinic (MDC) in mitigating any variations.

Methods: The study analyzed patients undergoing pancreaticoduodenectomy for pancreatic ductal adenocarcinoma in a large hospital system. The patients were categorized into groups of high and low SES and whether they were managed by the authors' pancreatic cancer MDC or not. The study compared differences in disease characteristics, receipt of multimodality therapy, perioperative outcomes, and recurrence-free and overall survival.

Results: Of the 162 low-SES patients and 119 high-SES patients, 54% were managed in the MDC. Outside the MDC, low-SES patients were less likely to receive neoadjuvant chemotherapy and had less minimally invasive surgery, a longer OR time, less enhanced recovery participation, and more major complications (p < 0.05). No SES disparities were observed among the MDC patients. Despite similar tumor characteristics, the low-SES patients had inferior median overall survival (21 vs 32 months; p = 0.005), but the MDC appeared to eliminate this disparity. Low SES correlated with inferior survival for the non-MDC patients (17 vs 32 months; p < 0.001), but not for the MDC patients (24 vs 25 months; p = 0.33). These findings persisted in the multivariable analysis.

Conclusion: A pancreatic cancer MDC standardizes treatment decisions, eliminates disparities in surgical outcomes, and improves survival for low-SES patients.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flow chart describing the patient cohort and categorization performed to analyze the relative influence of socioeconomic status (SES) and management by a multidisciplinary clinic (MDC) for pancreatic cancer patients at the University of Pittsburgh Medical Center (UPMC).
Figure 2.
Figure 2.
Kaplan–Meier univariate survival analysis assessing difference based on patient socioeconomic status (SES) in overall survival for (A) all patients, (B) patients managed outside the multidisciplinary clinic (MDC), and (C) two patients managed in the MDC.
See this image and copyright information in PMC

References

    1. Lutfi W, Zenati MS, Zureikat AH, Zeh HJ, Hogg ME. Health Disparities Impact Expected Treatment of Pancreatic Ductal Adenocarcinoma Nationally. Ann Surg Oncol 2018;25:1860–7. - PubMed
    1. Sridhar P, Misir P, Kwak H, et al. Impact of Race, Insurance Status, and Primary Language on Presentation, Treatment, and Outcomes of Patients with Pancreatic Adenocarcinoma at a Safety-Net Hospital. J Am Coll Surg 2019;229:389–96. - PubMed
    1. Shapiro M, Chen Q, Huang Q, et al. Associations of Socioeconomic Variables With Resection, Stage, and Survival in Patients With Early-Stage Pancreatic Cancer. JAMA Surg 2016;151:338–45. - PubMed
    1. Tohme S, Kaltenmeier C, Bou-Samra P, Varley PR, Tsung A. Race and Health Disparities in Patient Refusal of Surgery for Early-Stage Pancreatic Cancer: An NCDB Cohort Study. Ann Surg Oncol 2018;25:3427–35. - PubMed
    1. Kirkegård J, Ladekarl M, Fristrup CW, Hansen CP, Sall M, Mortensen FV. Urban versus rural residency and pancreatic cancer survival: A Danish nationwide population-based cohort study. PLoS One 2018;13:e0202486. - PMC - PubMed

LinkOut - more resources