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. 2022 Aug;126(2):302-313.
doi: 10.1002/jso.26859. Epub 2022 Mar 22.

Differences in receipt of multimodality therapy by race, insurance status, and socioeconomic disadvantage in patients with resected pancreatic cancer

Scarlett Hao  1 , Anastasios Mitsakos  1 , William Irish  1   2 , Janet Elizabeth Tuttle-Newhall  1 , Alexander A Parikh  1 , Rebecca A Snyder  1   2
Affiliations

Differences in receipt of multimodality therapy by race, insurance status, and socioeconomic disadvantage in patients with resected pancreatic cancer

Scarlett Hao et al. J Surg Oncol. 2022 Aug.

Abstract

BACKGROUND AND METHODS: Racial and socioeconomic disparities in receipt of adjuvant chemotherapy affect patients with pancreatic cancer. However, differences in receipt of neoadjuvant chemotherapy among patients undergoing resection are not well-understood. A retrospective cross-sectional cohort of patients with resected AJCC Stage I/II pancreatic ductal adenocarcinoma was identified from the National Cancer Database (2014-2017). Outcomes included receipt of neoadjuvant versus adjuvant chemotherapy, or receipt of either, defined as multimodality therapy and were assessed by univariate and multivariate analysis.

Results: Of 19 588 patients, 5098 (26%) received neoadjuvant chemotherapy, 9624 (49.1%) received adjuvant chemotherapy only, and 4757 (24.3%) received no chemotherapy. On multivariable analysis, Black patients had lower odds of neoadjuvant chemotherapy compared to White patients (OR: 0.80, 95% CI: 0.67-0.97) but no differences in receipt of multimodality therapy (OR: 0.89, 95% CI: 0.77-1.03). Patients with Medicaid or no insurance, low educational attainment, or low median income had significantly lower odds of receiving neoadjuvant chemotherapy or multimodality therapy.

Conclusions: Racial and socioeconomic disparities persist in receipt of neoadjuvant and multimodality therapy in patients with resected pancreatic adenocarcinoma.

Discussion: Policy and interventional implementations are needed to bridge the continued socioeconomic and racial disparity gap in pancreatic cancer care.

Keywords: healthcare disparity; multimodal treatment; neoadjuvant chemotherapy; pancreas cancer; socioeconomic factors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cohort selection
Figure 2
Figure 2
Odds of receiving neoadjuvant chemotherapy versus strictly adjuvant chemotherapy by multivariable regression, selected factors. HSD, high school degree
Figure 3
Figure 3
Odds of receiving multimodality therapy versus surgery alone by multivariable regression, selected factors.  HSD, high school degree
See this image and copyright information in PMC

Comment in

References

    1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7‐33. 10.3322/caac.21654 - DOI - PubMed
    1. Cervantes A, Waymouth EK, Petrov MS. African‐Americans and indigenous peoples have increased burden of diseases of the exocrine pancreas: a systematic review and meta‐analysis. Dig Dis Sci. 2019;64(1):249‐261. 10.1007/s10620-018-5291-1 - DOI - PubMed
    1. Heller DR, Nicolson NG, Ahuja N, Khan S, Kunstman JW. Association of treatment inequity and ancestry with pancreatic ductal adenocarcinoma survival. JAMA Surg. 2020;155(2):e195047. 10.1001/jamasurg.2019.5047 - DOI - PMC - PubMed
    1. Khawja SN, Mohammed S, Silberfein EJ, Musher BL, Fisher WE, Van Buren G 2nd. Pancreatic cancer disparities in African Americans. Pancreas. 2015;44(4):522‐527. 10.1097/MPA.0000000000000323 - DOI - PubMed
    1. Noel M, Fiscella K. Disparities in pancreatic cancer treatment and outcomes. Health Equity. 2019;3(1):532‐540. 10.1089/heq.2019.0057 - DOI - PMC - PubMed