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Disparities in NCCN Guideline-Compliant Care for Patients with Early-Stage Pancreatic Adenocarcinoma at Minority-Serving versus Non-Minority-Serving Hospitals

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Racial/ethnic disparities in pancreatic adenocarcinoma (PDAC) outcomes may relate to receipt of National Comprehensive Cancer Network (NCCN) guideline-compliant care. We assessed the association between treatment at minority-serving hospitals (MSH) and receipt of NCCN-compliant care.

Patients and Methods

Patients who underwent resection of early-stage PDAC between 2006 and 2019 were identified from the National Cancer Database (NCDB). MSH was defined as the top decile of facilities treating minority ethnicities (Black and/or Hispanic). Factors associated with receipt of NCCN-compliant care and its impact on overall survival (OS) were assessed.

Results

Among 44,873 patients who underwent resection of PDAC, most were treated at non-MSH (n = 42,571, 94.9%), while a smaller subset were treated at MSH (n = 2302, 5.1%). Patients treated at MSH were more likely to be at a younger median age (MSH 66 years versus non-MSH 67 years), Black or Hispanic (MSH 58.4% versus non-MSH 12.0%), and not insured (MSH 7.8% versus non-MSH 1.6%). While 71.7% (n = 31,182) of patients were compliant with NCCN care, guideline-compliant care was lower at MSH (MSH 62.5% versus non-MSH 72.2%). On multivariable analysis, receiving care at MSH was associated with not receiving guideline-compliant care [odds ratio (OR) 0.63, 95% confidence interval (CI) 0.53–0.74]. At non-MSH, non-white patients had lower odds of receiving guideline-compliant PDCA care (OR 0.85, 95% CI 0.78–0.91). Failure to comply was associated with worse overall survival (OS) [hazard ratio (HR) 1.50, 95% CI 1.46–1.54, all p < 0.001].

Conclusions

Patients with PDAC treated at MSH and minorities treated at non-MSH were less likely to receive NCCN-compliant care. Failure to comply with guideline-based PDAC treatment was associated with worse OS.

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Authors and Affiliations

  1. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Henrique A. Lima MD, Laura Alaimo MD, Zorays Moazzam MD, Yutaka Endo MD, PhD, Selamawit Woldesenbet PhD, Erryk Katayama BA, Muhammad Musaab Munir MD, Chanza Shaikh MD, Samantha M. Ruff MD, Mary Dillhoff MD, Joal Beane MD, Jordan Cloyd MD, Aslam Ejaz MD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

  2. Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil

    Henrique A. Lima MD & Vivian Resende MD, PhD

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Correspondence to Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.).

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Henrique A. Lima, Laura Alaimo, Zorays Moazzam, Yutaka Endo, Selamawit Woldesenbet, Erryk Katayama, Muhammad Musaab Munir, Chanza Shaikh, Samantha M. Ruff, Mary Dillhoff, Joal Beane, Jordan Cloyd, Aslam Ejaz, Vivian Resende, Timothy M. Pawlik has nothing to disclose.

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Lima, H.A., Alaimo, L., Moazzam, Z. et al. Disparities in NCCN Guideline-Compliant Care for Patients with Early-Stage Pancreatic Adenocarcinoma at Minority-Serving versus Non-Minority-Serving Hospitals. Ann Surg Oncol 30, 4363–4372 (2023). https://doi.org/10.1245/s10434-023-13230-y

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