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Journal of Gastrointestinal Surgery

, Volume 17, Issue 11, pp 1897–1906 | Cite as

Trends in Racial Disparities in Pancreatic Cancer Surgery

  • Anand Shah
  • K. S. Clifford Chao
  • Truls Østbye
  • Anthony W. Castleberry
  • Ricardo Pietrobon
  • Beat Gloor
  • Bryan M. Clary
  • Rebekah R. White
  • Mathias WorniEmail author
Original Article

Abstract

Objectives

We tested three hypotheses: (1) blacks with pancreatic cancer are recommended surgical resection less often than whites; (2) when recommended surgical resection, blacks refuse surgery more often than whites; and lastly, (3) racial differences in refusal of surgical resection have decreased over time.

Methods

A retrospective cohort study was conducted on patients with potentially resectable, nonmetastatic pancreatic adenocarcinoma of the Surveillance, Epidemiology, and End Results registry from 1988 to 2009. Univariate and multivariable logistic regression analyses were performed to assess whether differences in the proportion of whites versus blacks refusing surgery among patients recommended for resection changed over time.

Results

A total of 35,944 patients were included; most were white (87.6 %). After adjusting for covariates including tumor stage, pancreatic cancer resection was less often recommended to and performed in blacks compared with whites (adjusted odds ratio (aOR) 0.88, 95 % confidence interval (CI) 0.82–0.95; aOR 0.83, 95 % CI 0.76–0.91, respectively). Blacks also underwent surgical resection less often when surgery was recommended (aOR 0.73, 95 % CI 0.64–0.85). Racial disparities in surgery recommendation and its performance did not decrease from 1988 to 2009. In multivariable adjusted analyses, blacks refused surgery more often when it was recommended (aOR in 1988 4.75, 95 % CI 2.51–9.01); this disparity decreased over time (aOR 0.93 per year, 95 % CI 0.89–0.97).

Conclusions

Although racial disparities in pancreatic cancer surgery refusal have diminished over the past two decades, significant disparities in the recommendation and performance of surgery persist. It is likely that both provider- and patient-level factors have a substantial impact on surgery recommendation and its acceptance. The identification of such factors is critical to design a framework for eliminating disparities in cancer-directed surgery for pancreatic cancer.

Keywords

Disparity Race Ethnicity Pancreatic adenocarcinoma Pancreatic cancer Pancreatic resection 

References

  1. 1.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA: Cancer Journal for Clinicians. 62(1):10–29.Google Scholar
  2. 2.
    SEER. SEER Stat Fact Sheets: Pancreas [Internet]. Surveillance, Epidemiology, and End Results (SEER) Program. 2012 [cited 2012 Dec 10]. Available from: http://seer.cancer.gov/statfacts/html/pancreas.html
  3. 3.
    Fesinmeyer MD, Austin MA, Li CI, De Roos AJ, Bowen DJ. Differences in survival by histologic type of pancreatic cancer. Cancer Epidemiology, Biomarkers & Prevention. 2005 Jul;14(7):1766–73.Google Scholar
  4. 4.
    Jinjuvadia R, Jinjuvadia K, Liangpunsakul S. Racial Disparities in Gastrointestinal Cancers-Related Mortality in the US Population. Digestive Diseases and Sciences. 2013 58:236–243, Jul 15Google Scholar
  5. 5.
    Murphy MM, Simons JP, Hill JS, McDade TP, Chau Ng S, Whalen GF, et al. Pancreatic resection: a key component to reducing racial disparities in pancreatic adenocarcinoma. Cancer. 2009 Sep 1;115(17):3979–90.Google Scholar
  6. 6.
    Eloubeidi MA, Desmond RA, Wilcox CM, Wilson RJ, Manchikalapati P, Fouad MM, et al. Prognostic factors for survival in pancreatic cancer: a population-based study. American Journal of Surgery. 2006 Sep;192(3):322–9.Google Scholar
  7. 7.
    SEER. SEER [Internet]. Surveillance, Epidemiology, and End Results (SEER) Program. 2012 [cited 2012 Dec 10]. Available from: http://seer.cancer.gov/
  8. 8.
    Amin S, McBride RB, Kline JK, Mitchel EB, Lucas AL, Neugut AI, et al. Incidence of subsequent pancreatic adenocarcinoma in patients with a history of nonpancreatic primary cancers. Cancer. 2012 Mar 1;118(5):1244–51.Google Scholar
  9. 9.
    National Cancer Institute. Center to Reduce Health Disparities. [Internet]. Available from: http://crchd.cancer.gov/
  10. 10.
    Agency for Healthcare Research and Quality. Activities to Reduce Racial and Ethnic Disparities in Health Care. [Internet]. Available from: http://www.ahrq.gov/qual/disparities.htm
  11. 11.
    Bilimoria KY, Ko CY, Tomlinson JS, Stewart AK, Talamonti MS, Hynes DL, et al. Wait times for cancer surgery in the United States: trends and predictors of delays. Annals of Surgery. 2011 Apr;253(4):779–85.Google Scholar
  12. 12.
    Moskowitz GB, Stone J, Childs A. Implicit stereotyping and medical decisions: unconscious stereotype activation in practitioners’ thoughts about African Americans. American Journal of Public Health. 2012 May;102(5):996–1001.Google Scholar
  13. 13.
    Manfredi C, Kaiser K, Matthews AK, Johnson TP. Are racial differences in patient-physician cancer communication and information explained by background, predisposing, and enabling factors? Journal of Health Communication. 2010 Apr;15(3):272–92.Google Scholar
  14. 14.
    Hausmann LRM, Mor M, Hanusa BH, Zickmund S, Cohen PZ, Grant R, et al. The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting. Journal of General Internal Medicine. 2010 Sep;25(9):982–8.Google Scholar
  15. 15.
    Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS. National failure to operate on early stage pancreatic cancer. Annals of Surgery. 2007 Aug;246(2):173–80.Google Scholar
  16. 16.
    McGhan LJ, Etzioni DA, Gray RJ, Pockaj BA, Coan KE, Wasif N. Underuse of curative surgery for early stage upper gastrointestinal cancers in the United States. Journal of Surgical Research. 2012 Sep;177(1):55–62.Google Scholar
  17. 17.
    Musa D, Schulz R, Harris R, Silverman M, Thomas SB. Trust in the health care system and the use of preventive health services by older black and white adults. American Journal of Public Health. 2009 Jul;99(7):1293–9.Google Scholar
  18. 18.
    Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. Journal of Cultural Diversity. 2007 Jan;14(2):56–60.Google Scholar
  19. 19.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999 Aug 11;282(6):583–9.Google Scholar
  20. 20.
    Cykert S, Dilworth-Anderson P, Monroe MH, Walker P, McGuire FR, Corbie-Smith G, et al. Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer. JAMA. 2010 Jun 16;303(23):2368–76.Google Scholar
  21. 21.
    Winker MA. Measuring race and ethnicity: why and how? JAMA. 2004 Oct 6;292(13):1612–4.Google Scholar
  22. 22.
    Schwartz KL, Crossley-May H, Vigneau FD, Brown K, Banerjee M. Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes & Control. 2003 Oct;14(8):761–6.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Anand Shah
    • 1
  • K. S. Clifford Chao
    • 1
  • Truls Østbye
    • 2
  • Anthony W. Castleberry
    • 3
  • Ricardo Pietrobon
    • 3
  • Beat Gloor
    • 4
  • Bryan M. Clary
    • 3
  • Rebekah R. White
    • 3
  • Mathias Worni
    • 3
    • 4
    Email author
  1. 1.Department of Radiation OncologyColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Community and Family MedicineDuke University Medical CenterDurhamUSA
  3. 3.Department of SurgeryDuke University Medical CenterDurhamUSA
  4. 4.Department of Visceral Surgery and Medicine, InselspitalUniversity of BernBernSwitzerland

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