Racial disparities in the treatment of pancreatic cancer: results from the analysis of a National Database

Abstract

Background:. Pancreatic cancer is the third leading cause of cancer death in the US. There have been postulates of racial disparities. Based on this, we primarily examined the presence of race, for the diagnosis and treatment of pancreatic cancer. Methods:. A retrospective review was conducted on patients with pancreatic cancers using the Surveillance Epidemiology, and End Results - Medicare registry. Univariate and multivariate analyses were performed. Overall Survival analysis was done using the Kaplan-Meier curve. Comparison of survival curves was done using the log-rank test. Cox proportional hazards regression model was used to determine independent predictors of survival. Other areas focused on were time interval from diagnosis to treatment, “Predictors of surgery of the primary site,” “Predictors for recommending surgery of the primary site,” “Predictors for oncologic resection,” “Predictors of performance and refusal of surgery of primary site if recommended,” and “Predictors for any other therapy (all therapies excluding surgery). Results:. A total of 52,951 patients were identified from the database. A total of 24,523 were males and 26,715 were females. A total of 81.9% were Caucasian, 10.9% were Black, and 7.2% were other races. There was approximately equal distribution of the different stages between both genders. A total of 10.2% of the females were diagnosed at stage I, 28.9%, 9.3%, and 51.6% at stages I, III, and IV, respectively, compared to males with 8.4%, 28.3%, 9.2%, and 54.1% for stages I, II, III, and IV, respectively. A total of 9.5% of the Black patients were diagnosed at stage I, 24.2% at stage II, 10.1% at stage III, and 56.2% at stage IV. A similar distribution was noted in the other races. Black patients had worse overall survival when compared to Caucasians (P = .004) and other races (P = .001). Conclusion:. Compared to Caucasian patients, Black patients with pancreatic cancer had worse overall survival.