Racial Differences in Cancer Specialist Consultation, Treatment, and Outcomes for Locoregional Pancreatic Adenocarcinoma
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Blacks have a higher incidence of pancreatic adenocarcinoma and worse outcomes compared to whites. Identifying barriers in pancreatic cancer care may explain survival differences and provide areas for intervention.
Pancreatic adenocarcinoma patients were identified in the Surveillance, Epidemiology, and End Results Registry (1991–2002). Treatment and outcome data were obtained from the linked Surveillance, Epidemiology, and End Results Registry–Medicare databases. Logistic regression was used to assess race as a predictor of specialist consultation/receipt of therapy. Kaplan–Meier survival curves were compared. Cox proportional hazard analyses were performed to estimate survival after adjustment for patient and treatment characteristics.
A total of 13,230 white patients (90%) and 1478 black patients (10%) were identified. Clinical/pathologic factors were compared by race. When we compared whites and blacks by univariate analyses, blacks had lower rates of specialist consultation (P < .01), chemotherapy (P < .01), and resection (P < .01). On multivariate analyses predicting consultation with a cancer specialist, black race negatively predicted consultation with a medical oncologist (adjusted odds ratio [AOR] .74, P < .01), radiation oncologist (AOR .75, P < .01), and surgeon (AOR .71, P < .01). For predicting receipt of therapy after consultation, blacks were less likely to undergo chemotherapy (AOR .59, P < .01) and resection (AOR .79, P = .05). Blacks had worse overall survival on Kaplan–Meier survival curves (log rank, P < .0001). On Cox proportional hazard modeling evaluating survival, black race was no longer independently associated with worse survival after adjustment for resection and adjuvant therapy (hazard ratio, 1.08; 95% confidence interval, .99–1.19).
Racial disparities exist in pancreatic cancer specialist consultation and subsequent therapy use. Because receipt of care is fundamental to reducing outcome discrepancies, these barriers serve as discrete intervention points to ensure all locoregional pancreatic adenocarcinoma patients receive appropriate specialist referral and subsequent therapy.
- Jemal, A, Siegel, R, Ward, E (2008) Cancer statistics, 2008. CA Cancer J Clin 58: pp. 71-96 CrossRef
- National Cancer Institute. SEER cancer statistics review 2005: age-adjusted SEER incidence and US death rates and 5-year relative survival rates. http://seer.cancer.gov/csr/1975_2005/. Accessed 4 Aug 2009.
- Horner M, Ries LAG, Krapcho M, et al. SEER cancer statistics review, 1975–2006. Bethesda, MD: National Cancer Institute; 2009. http://seer.cancer.gov/csr/1975_2006. Accessed 4 Aug 2009.
- Fesinmeyer, MD, Austin, MA, Li, CI, Roos, AJ, Bowen, DJ (2005) Differences in survival by histologic type of pancreatic cancer. Cancer Epidemiol Biomarkers Prev 14: pp. 1766-1773 CrossRef
- Warshaw, AL, Fernandez-del Castillo, C (1992) Pancreatic carcinoma. N Engl J Med 326: pp. 455-465
- Bertagnolli, MM (2005) Surgical prevention of cancer. J Clin Oncol 23: pp. 324-332 CrossRef
- Kalser, MH, Ellenberg, SS (1985) Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 120: pp. 899-903
- Neoptolemos, JP, Dunn, JA, Stocken, DD (2001) Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet 358: pp. 1576-1585 CrossRef
- Chua, YJ, Cunningham, D (2005) Adjuvant treatment for resectable pancreatic cancer. J Clin Oncol 23: pp. 4532-4537 CrossRef
- Oettle, H, Post, S, Neuhaus, P (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297: pp. 267-277 CrossRef
- Shavers, VL, Brown, ML (2002) Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst 94: pp. 334-357
- Ayanian, JZ, Zaslavsky, AM, Fuchs, CS (2003) Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. J Clin Oncol 21: pp. 1293-1300 CrossRef
- O’Malley, CD, Le, GM, Glaser, SL, Shema, SJ, West, DW (2003) Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study. Cancer 97: pp. 1303-1311 CrossRef
- Steyerberg, EW, Neville, B, Weeks, JC, Earle, CC (2007) Referral patterns, treatment choices, and outcomes in locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol 25: pp. 2389-2396 CrossRef
- Steyerberg, EW, Earle, CC, Neville, BA, Weeks, JC (2005) Racial differences in surgical evaluation, treatment, and outcome of locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol 23: pp. 510-517 CrossRef
- McCann, J, Artinian, V, Duhaime, L (2005) Evaluation of the causes for racial disparity in surgical treatment of early stage lung cancer. Chest 128: pp. 3440-3446 CrossRef
- Bach, PB, Cramer, LD, Warren, JL, Begg, CB (1999) Racial differences in the treatment of early-stage lung cancer. N Engl J Med 341: pp. 1198-1205 CrossRef
- Rogers, SO, Ray, WA, Smalley, WE (2004) A population-based study of survival among elderly persons diagnosed with colorectal cancer: does race matter if all are insured? (United States). Cancer Causes Control 15: pp. 193-199 CrossRef
- Murphy MM, Simons JP, Hill J, Tseng JF. Pancreatic resection: a key component to reducing racial disparities in pancreatic adenocarcinoma. Cancer (2009). [Epub ahead of print].
- Earle, CC, Neumann, PJ, Gelber, RD, Weinstein, MC, Weeks, JC (2002) Impact of referral patterns on the use of chemotherapy for lung cancer. J Clin Oncol 20: pp. 1786-1792 CrossRef
- Tseng, JF, Kronowitz, SJ, Sun, CC (2004) The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer 101: pp. 1514-1523 CrossRef
- Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40 Suppl 8:IV-3–18.
- Potosky, AL, Riley, GF, Lubitz, JD, Mentnech, RM, Kessler, LG (1993) Potential for cancer related health services research using a linked Medicare-tumor registry database. Med Care 31: pp. 732-748 CrossRef
- World Health Organization. International classification of diseases for oncology. 3rd ed. Geneva: World Health Organization; 2000.
- Bilimoria, KY, Bentrem, DJ, Ko, CY (2007) National failure to operate on early stage pancreatic cancer. Ann Surg 246: pp. 173-180 CrossRef
- Zell, JA, Rhee, JM, Ziogas, A, Lipkin, SM, Anton-Culver, H (2007) Race, socioeconomic status, treatment, and survival time among pancreatic cancer cases in California. Cancer Epidemiol Biomarkers Prev 16: pp. 546-552 CrossRef
- Bach PB, Guadagnoli E, Schrag D, Schussler N, Warren JL. Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations. Med Care. 2002;40 Suppl 8:IV-19–25.
- Klabunde CN, Warren JL, Legler JM. Assessing comorbidity using claims data: an overview. Med Care. 2002;40 Suppl 8:IV-26–35.
- Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40: pp. 373-383 CrossRef
- Deyo, RA, Cherkin, DC, Ciol, MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45: pp. 613-619 CrossRef
- Virnig BA, Warren JL, Cooper GS, et al. Studying radiation therapy using SEER-Medicare-linked data. Med Care. 2002;40 Suppl 8:IV-49–54.
- International classification of diseases. 9th rev., clinical modification. Salt Lake City: Medicode Publications; 2001.
- Kaplan, EL, Meier, P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assn 185: pp. 1457-1481
- Eloubeidi, MA, Desmond, RA, Wilcox, CM (2006) Prognostic factors for survival in pancreatic cancer: a population-based study. Am J Surg 192: pp. 322-329 CrossRef
- Krzyzanowska, MK, Weeks, JC, Earle, CC (2003) Treatment of locally advanced pancreatic cancer in the real world: population-based practices and effectiveness. J Clin Oncol 21: pp. 3409-3414 CrossRef
- Davila, JA, Chiao, EY, Hasche, JC (2009) Utilization and determinants of adjuvant therapy among older patients who receive curative surgery for pancreatic cancer. Pancreas 38: pp. e18-e25 CrossRef
- Sewitch, MJ, Fournier, C, Dawes, M (2007) Do physician recommendations for colorectal cancer screening differ by patient age?. Can J Gastroenterol 21: pp. 435-438
- Samet, J, Hunt, WC, Key, C, Humble, CG, Goodwin, JS (1986) Choice of cancer therapy varies with age of patient. JAMA 255: pp. 3385-3390 CrossRef
- Rathore, SS, Krumholz, HM (2004) Differences, disparities, and biases: clarifying racial variations in health care use. Ann Intern Med 141: pp. 635-638
- Dein S. Explanatory models of and attitudes towards cancer in different cultures. Lancet Oncol. 2004;5:119–24.
- Whittle, J, Conigliaro, J, Good, CB, Joswiak, M (1997) Do patient preferences contribute to racial differences in cardiovascular procedure use?. J Gen Intern Med 12: pp. 267-273 CrossRef
- Oddone, EZ, Horner, RD, Diers, T (1998) Understanding racial variation in the use of carotid endarterectomy: the role of aversion to surgery. J Natl Med Assoc 90: pp. 25-33
- Lannon, C, Brack, V, Stuart, J (1995) What mothers say about why poor children fall behind on immunizations. A summary of focus groups in North Carolina. Arch Pediatr Adolesc Med 149: pp. 1070-1075
- Bach, PB, Pham, HH, Schrag, D, Tate, RC, Hargraves, JL (2004) Primary care physicians who treat blacks and whites. N Engl J Med 351: pp. 575-584 CrossRef
- Ayanian, JZ, Kohler, BA, Abe, T, Epstein, AM (1993) The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med 329: pp. 326-331 CrossRef
- Perez-Stable, EJ, Sabogal, F, Otero-Sabogal, R, Hiatt, RA, McPhee, SJ (1992) Misconceptions about cancer among Latinos and Anglos. JAMA 268: pp. 3219-3223 CrossRef
- Fox, SA, Stein, JA (1991) The effect of physician-patient communication on mammography utilization by different ethnic groups. Med Care 29: pp. 1065-1082 CrossRef
- Womeodu, RJ, Bailey, JE (1996) Barriers to cancer screening. Med Clin North Am 80: pp. 115-133 CrossRef
- Ayanian, JZ, Cleary, PD, Keogh, JH (2004) Physicians’ beliefs about racial differences in referral for renal transplantation. Am J Kidney Dis 43: pp. 350-357 CrossRef
- Ibrahim, SA, Whittle, J, Bean-Mayberry, B (2003) Racial/ethnic variations in physician recommendations for cardiac revascularization. Am J Public Health 93: pp. 1689-1693 CrossRef
- Racial Differences in Cancer Specialist Consultation, Treatment, and Outcomes for Locoregional Pancreatic Adenocarcinoma
Annals of Surgical Oncology
Volume 16, Issue 11 , pp 2968-2977
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- 1. Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, MA, USA
- 2. Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada