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24.04.2018 | Pancreatic Tumors | Ausgabe 7/2018

Annals of Surgical Oncology 7/2018

Health Disparities Impact Expected Treatment of Pancreatic Ductal Adenocarcinoma Nationally

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 7/2018
Autoren:
BS Waseem Lutfi, MD, MPH, PhD Mazen S. Zenati, MD Amer H. Zureikat, MD Herbert J. Zeh, MD, MS Melissa E. Hogg
Wichtige Hinweise
This study was presented as a short oral presentation at the 13th annual Academic Surgical Congress on 1 February 2018.

Abstract

Background and Purpose

National adherence to treatment guidelines for pancreatic ductal adenocarcinoma (PDAC) is a concern. This study aims to evaluate national expected treatment (ET) adherence for all PDAC stages. We hypothesized that both patient and hospital demographics are associated with national ET disparities for PDAC.

Methods

Clinical stage I through IV PDAC patients were evaluated using the National Cancer Data Base from 2004 to 2013. ET was defined as surgery for stage I/II, chemotherapy or radiation for stage III, and chemotherapy for stage IV. Unexpected treatment (UT) was defined as no surgery for stage I/II, surgery for stage III, and radiation or surgery for stage IV. No treatment is denoted by NT.

Results

171,351 patients were identified, of whom 56,589 (33.0%) were stage I/II, 23,459 (13.7%) were stage III, and 91,303 (53.3%) were stage IV. Of patients, 48.4% received ET, 14.7% received UT, and 36.9% received NT. ET rates were 41.1% for stage I/II, 65.4% for stage III, and 48.5% for stage IV patients. On multivariable analysis, older age, non-White race, lower socioeconomic status, being uninsured or Medicaid, increased comorbidities, nonacademic centers, and low-volume hospitals were independent negative predictors of receiving ET (P < 0.01). On subgroup analysis, high-volume academic centers had similar negative predictors of ET despite higher ET adherence overall (P < 0.01).

Conclusions

Patient and hospital factors impact ET of PDAC on a national level. These treatment disparities for PDAC are concerning, even at high-volume academic centers. Future studies need to identify the causes of treatment disparities for PDAC with intervention measures aimed to relieve treatment disparities.

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