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. 2024 Feb;13(3):e7020.
doi: 10.1002/cam4.7020.

Accessibility to ERCP-performing hospitals among patients with pancreatic cancer living in SEER regions

Anna Tavakkoli  1   2 , Alaina Beauchamp  3 , Tanushree Prasad  3 , Hong Zhu  4 , Amit G Singal  1   2 , B Joseph Elmunzer  5 , Nisa M Kubiliun  1 , Richard S Kwon  6 , Amy E Hughes  2   3 , Sandi L Pruitt  2   3
Affiliations

Accessibility to ERCP-performing hospitals among patients with pancreatic cancer living in SEER regions

Anna Tavakkoli et al. Cancer Med. 2024 Feb.

Abstract

Background and aims: The two most common interventions used to treat painless jaundice from pancreatic cancer are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD). Our study aimed to characterize the geographic distribution of ERCP-performing hospitals among patients with pancreatic cancer in the United States and the association between geographic accessibility to ERCP-performing hospitals and biliary interventions patients receive.

Methods: This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database for pancreatic cancer from 2005 to 2013. Multilevel models were used to examine the association between accessibility to ERCP hospitals within a 30- and 45-min drive from the patient's residential ZIP Code and the receipt of ERCP treatment. A two-step floating catchment area model was used to calculate the measure of accessibility based on the distribution across SEER regions.

Results: 7464 and 782 patients underwent ERCP and PTBD, respectively, over the study period. There were 808 hospitals in which 8246 patients diagnosed with pancreatic cancer in SEER regions from 2005 to 2013 received a procedure. Patients with high accessibility within both 30- and 45-min drive to an ERCP-performing hospital were more likely to receive an ERCP (30-min adjusted odds ratio [aOR]: 1.53, 95% confidence interval [CI]: 1.17-2.01; 45-min aOR: 1.31, 95% CI: 1.01-1.70). Furthermore, in the adjusted model, Black patients (vs. White) and patients with stage IV disease were less likely to receive ERCP than PTBD.

Conclusions: Patients with pancreatic cancer and high accessibility to an ERCP-performing hospital were more likely to receive ERCP. Disparities in the receipt of ERCP persisted for Black patients regardless of their access to ERCP-performing hospitals.

Keywords: ERCP; accessibility; disparities; pancreatic cancer.

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Conflict of interest statement

Anna Tavakkoli, Alaina Beauchamp, Tanushree Prasad, Hong Zhu, Nisa Kubiliun, Richard Kwon, and Amy Hughes disclose no conflicts of interest. Unrelated to this work, Sandi Pruitt serves as a consultant for Pfizer and Gilead, and Amit Singal has served as a consultant or on advisory boards for Genentech, AstraZeneca, Eisai, Bayer, Exelixis, Boston Scientific, Fujifilm Medical Sciences, Exact Sciences, Roche, Glycotest, Freenome, and GRAIL.

Figures

FIGURE 1
FIGURE 1
SEER registry accessibility to ERCP‐performing facility within 30 and 45 min. ERCP, endoscopic retrograde cholangiopancreatography; SEER, Surveillance, Epidemiology, and End Results Program.
FIGURE 2
FIGURE 2
Kaplan–Meier failure estimates comparing Black and White patients undergoing ERCP with both high and low 30‐min accessibility. ERCP, endoscopic retrograde cholangiopancreatography.
See this image and copyright information in PMC

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