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A Multi-institutional Study of Pancreatic Cancer in Harris County, Texas: Race Predicts Treatment and Survival

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Racial disparities exist for patients with pancreatic cancer. This observation has primarily been noted in the Surveillance, Epidemiology, and End Results database and has focused primarily on whites and African Americans. We sought to determine if these disparities exist in a local, racially diverse patient population.

Methods

Retrospective review of a pancreatic cancer tumor registry from two hospital systems from 1998 to 2010. Clinicopathologic parameters were recorded. Statistical analysis was performed by analysis of variance, Chi square test, Kaplan–Meier survival analysis, log rank test, and regression models.

Results

A total of 1039 patients were identified for this study. Hispanic and African American patients presented at an earlier age when compared to whites. There was no difference in gender or stage at presentation between racial groups. Adjusted for stage, race was predictive of chemotherapy administration. Independent predictors of increased mortality included male gender, African American race, stage at diagnosis, and older age.

Conclusions

Despite adjusting for covariates, survival remains lowest for African American patients. Further investigation is needed to understand the effect of race and how it mediates treatment and survival in those with pancreatic cancer.

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References

  1. Agency for Healthcare Research and Quality. 2010 national healthcare quality and disparities reports. http://www.ahrq.gov/qual/qrdr10.htm.

  2. Murray CJ, Kulkarni SC, Michaud C, et al. Eight Americas: investigating mortality disparities across races, counties, and race–counties in the United States. PLoS Med. 2006;3:e260.

    Article  PubMed  Google Scholar 

  3. American Cancer Society. Cancer facts and figures, 2010. http://www.cancer.org/acs/groups/content/@nho/documents/document/acspc-024113.pdf.

  4. Gehlert S, Colditz GA. Cancer disparities: unmet challenges in the elimination of disparities. Cancer Epidemiol Biomarkers Prev. 2011;20:1809–14.

    Article  PubMed  Google Scholar 

  5. Murphy MM, Simons JP, Hill JS, et al. Pancreatic resection: a key component to reducing racial disparities in pancreatic adenocarcinoma. Cancer. 2009;115:3979–90.

    Article  PubMed  Google Scholar 

  6. Riall TS, Townsend CM Jr, Kuo YF, et al. Dissecting racial disparities in the treatment of patients with locoregional pancreatic cancer: a 2-step process. Cancer. 2010;116:930–9.

    Article  PubMed  Google Scholar 

  7. Cheung MC, Yang R, Byrne MM, et al. Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma? Cancer. 2010;116:723–33.

    Article  PubMed  Google Scholar 

  8. U.S. Census Bureau. State and county quickfacts, 2010. http://quickfacts.census.gov/qfd/index.html.

  9. Steyerberg EW, Eijkemans MJ, Harrell FE Jr, et al. Prognostic modelling with logistic regression analysis: a comparison of selection and estimation methods in small data sets. Stat Med. 2000;19:1059–79.

    Article  PubMed  CAS  Google Scholar 

  10. Harrell WA, Spaulding LM. Social psychological models of choice behavior and drivers’ left turns. J Soc Psychol. 2001;141:714–22.

    Article  PubMed  CAS  Google Scholar 

  11. Royston P, Moons KG, Altman DG, et al. Prognosis and prognostic research: developing a prognostic model. BMJ. 2009;338:b604.

    Article  PubMed  Google Scholar 

  12. Cummings P. Estimating adjusted risk ratios for matched and unmatched data: an update. Stata J. 2011;11:290–8.

    Google Scholar 

  13. Murphy MM, Simons JP, Ng SC, et al. Racial differences in cancer specialist consultation, treatment, and outcomes for locoregional pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:2968–77.

    Article  PubMed  Google Scholar 

  14. Chang DC, Zhang Y, Mukherjee D, et al. Variations in referral patterns to high-volume centers for pancreatic cancer. J Am Coll Surg. 2009;209:720–6.

    Article  PubMed  Google Scholar 

  15. Riall TS, Lillemoe KD. Underutilization of surgical resection in patients with localized pancreatic cancer. Ann Surg. 2007;246:181–2.

    Article  PubMed  Google Scholar 

  16. Shavers VL, Harlan LC, Jackson M, et al. Racial/ethnic patterns of care for pancreatic cancer. J Palliat Med. 2009;12:623–30.

    Article  PubMed  Google Scholar 

  17. Arnold LD, Patel AV, Yan Y, et al. Are racial disparities in pancreatic cancer explained by smoking and overweight/obesity? Cancer Epidemiol Biomarkers Prev. 2009;18:2397–405.

    Article  PubMed  Google Scholar 

  18. Morris AM, Rhoads KF, Stain SC, et al. Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg. 2010;211:105–13.

    Article  PubMed  Google Scholar 

  19. Freeman HP, and Chu KC. Determinants of cancer disparities: barriers to cancer screening, diagnosis, and treatment. Surg Oncol Clin N Am. 2005;14:655–69.

    Article  PubMed  Google Scholar 

  20. Landrum MB, Keating NL, Lamont EB, et al. Reasons for underuse of recommended therapies for colorectal and lung cancer in the Veterans Health Administration. Cancer. 2011. doi:10.1002/cncr.26628.

  21. Baldwin LM, Dobie SA, Billingsley K, et al. Explaining black–white differences in receipt of recommended colon cancer treatment. J Natl Cancer Inst. 2005;97:1211–20.

    Article  PubMed  Google Scholar 

  22. Dimou A, Syrigos KN, Saif MW. Disparities in colorectal cancer in African-Americans vs whites: before and after diagnosis. World J Gastroenterol. 2009;15:3734–43.

    Article  PubMed  Google Scholar 

  23. Hershman D, McBride R, Jacobson JS, et al. Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol. 2005;23:6639–46.

    Article  PubMed  Google Scholar 

  24. Morris AM, Billingsley KG, Hayanga AJ, et al. Residual treatment disparities after oncology referral for rectal cancer. J Natl Cancer Inst. 2008;100:738–44.

    Article  PubMed  Google Scholar 

  25. Sail K, Franzini L, Lairson D, et al. Differences in treatment and survival among African-American and Caucasian women with early stage operable breast cancer. Ethn Health. 2011. doi:10.1080/13557858.2011.628011.

  26. Alexander DD, Waterbor J, Hughes T, et al. African-American and Caucasian disparities in colorectal cancer mortality and survival by data source: an epidemiologic review. Cancer Biomark. 2007;3:301–13.

    PubMed  Google Scholar 

  27. American College of Surgeons. CoC quality of cancer measures. Rev. March 2, 2011. http://www.facs.org/cancer/qualitymeasures.html.

  28. Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54:78–93.

    Article  PubMed  Google Scholar 

  29. Yu JB, Gross CP, Wilson LD, et al. NCI SEER public-use data: applications and limitations in oncology research. Oncology (Williston Park). 2009;23:288–95.

    Google Scholar 

  30. Singal V, Singal AK, Kuo YF. Racial disparities in treatment for pancreatic cancer and impact on survival: a population-based analysis. J Cancer Res Clin Oncol. 2012;138:715–22.

    Article  PubMed  Google Scholar 

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Correspondence to Curtis J. Wray MD.

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Wray, C.J., Castro-Echeverry, E., Silberfein, E.J. et al. A Multi-institutional Study of Pancreatic Cancer in Harris County, Texas: Race Predicts Treatment and Survival. Ann Surg Oncol 19, 2776–2781 (2012). https://doi.org/10.1245/s10434-012-2361-z

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  • DOI: https://doi.org/10.1245/s10434-012-2361-z

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