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Trends in Racial Disparities in Pancreatic Cancer Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA: Cancer Journal for Clinicians. 62(1):10–29.

  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. 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.

  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 15

  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.

  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.

  7. SEER. SEER [Internet]. Surveillance, Epidemiology, and End Results (SEER) Program. 2012 [cited 2012 Dec 10]. Available from: http://seer.cancer.gov/

  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.

  9. National Cancer Institute. Center to Reduce Health Disparities. [Internet]. Available from: http://crchd.cancer.gov/

  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. 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.

  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.

  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.

  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.

  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.

  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.

  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.

  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.

  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.

  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.

  21. Winker MA. Measuring race and ethnicity: why and how? JAMA. 2004 Oct 6;292(13):1612–4.

  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.

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Authors and Affiliations

  1. Department of Radiation Oncology, Columbia University Medical Center, New York, NY, USA

    Anand Shah & K. S. Clifford Chao

  2. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA

    Truls Østbye

  3. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Anthony W. Castleberry, Ricardo Pietrobon, Bryan M. Clary, Rebekah R. White & Mathias Worni

  4. Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, CH-3010, Switzerland

    Beat Gloor & Mathias Worni

Authors
  1. Anand Shah
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  2. K. S. Clifford Chao
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  3. Truls Østbye
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  4. Anthony W. Castleberry
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  5. Ricardo Pietrobon
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  6. Beat Gloor
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  7. Bryan M. Clary
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  8. Rebekah R. White
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  9. Mathias Worni
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Correspondence to Mathias Worni.

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Shah, A., Chao, K.S.C., Østbye, T. et al. Trends in Racial Disparities in Pancreatic Cancer Surgery. J Gastrointest Surg 17, 1897–1906 (2013). https://doi.org/10.1007/s11605-013-2304-4

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  • DOI: https://doi.org/10.1007/s11605-013-2304-4

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