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Socioeconomic factors linked to surgery receipt, survival in early-stage pancreatic cancer
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Socioeconomic variables such as race, ethnicity, geographic location, and marital and insurance status appeared associated with disparities in the use of surgical resection among patients with early-stage pancreatic cancer, according to results of a SEER analysis.
U.S. geographic location also appeared to independently predict survival outcomes, results showed. Patients from the Southeast demonstrated the poorest survival outcomes.
Jason S. Gold, MD, chief of surgical oncology and surgical service at the VA Boston Healthcare System and assistant professor of surgery at Harvard Medical School, and colleagues sought to evaluate the relationship between socioeconomic factors — including sex, race, ethnicity, martial status and insurance status — and receipt of surgical resection among patients with early-stage pancreatic cancer. Researchers also evaluated how these socioeconomic factors impacted survival among patients who did undergo surgery.
“As progress is made in the prevention and treatment of other malignant neoplasms without comparable progress in pancreatic cancer, its relative burden continues to increase,” Gold and colleagues wrote. “While breakthroughs in prevention and treatment are desperately needed for this disease, in the absence of such advances, progress can still be made by addressing disparities in the delivery of available treatment.”
Researchers used the SEER database to identify 17,530 patients (median age, 70 years) diagnosed with localized, nonmetastatic pancreatic cancer between 2004 and 2011. Most of the cohort were women (52.2%), non-Hispanic (91.9%) and white (81%). A majority of patients were insured (97.4%) and married (56.9%).
The rate of resection among these patients was 45.4% and did not change during the study period.
Overall, patients appeared more likely to undergo resection if they were white vs. black (OR = 0.76; 95% CI, 0.65-0.88) and non-Hispanic vs. Hispanic (OR = 0.72; 95% CI, 0.6-0.85).
Further, receipt of surgical resection was more common among patients who were married (OR = 1.42; 95% CI, 1.3-1.57) and insured (OR = 1.63; 95% CI, 1.22-2.18).
Surgical resection also appeared more likely among patients who lived in the Northeast region vs. Southeast region (OR = 1.67; 95% CI, 1.44-1.94).
Disease stage at the time of presentation was correlated with ethnicity (P = .003) as well as sex, race, marital status and geographical region (P < .001 for all).
Surgical resection prolonged disease-specific survival (21 months vs. 6 months; HR for disease-specific death = 0.32; 95% CI, 0.31-0.33).
Further, among patients who underwent surgery, disease-specific survival appeared longer among patients in the Pacific West (HR for death = 0.71; 95% CI, 0.63-0.79), Northeast (HR = 0.77; 95% CI, 0.67-0.88) and Midwest (HR = 0.77; 95% CI, 0.64-0.91) compared with patients in the Southeast (P < .001 for all).
The researchers noted that the exclusion of chemotherapy receipt, comorbidities and margin status follow surgery from the SEER database may be limitations to these findings.
“Understanding the factors involved in treatment and survival of patients with pancreatic cancer is an essential part of targeting areas for improvement of outcomes with this disease,” Gold and colleagues concluded.
These study findings are vital to improve the understanding of the disparities that exist in cancer care, Daniel A. Anaya, MD, and Mokenge P. Malafa, MD, both of Moffitt Cancer Center, wrote in an accompanying editorial.
“Going forward, parallel efforts should be geared to continue improving treatment options and delivery of care for pancreatic cancer — from a public health perspective,” they wrote. “However, efforts targeted at improving the delivery of care are likely to have a higher impact in the short term than any other current intervention.
“Improving regionalization of pancreatic cancer care by increasing access to referral centers and standardizing evidence-based multidisciplinary care at these referring sites should be the focus of future interventions.” – by Anthony SanFilippo
Disclosure: The researchers, Anaya and Malafa report no relevant financial disclosures.
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