101 The Effect of Disability on the Diagnosis and Treatment of Pancreatic Cancer in the Republic of Korea: A National Cohort Study

Abstract

INTRODUCTION: Pancreatic ductal adenocarcinoma (PC) is the fifth leading cause of cancer-related mortality and the eighth most common cancer in Korea. Korea has various national databases that can provide information regarding different health status factors, such as disability status, cancer, and delivery of health-care and associated medical costs. This study aimed to determine whether the diagnosis, treatment approach and prognosis of pancreatic cancer (PC) varied according to the presence, severity and type of disability. METHODS: Demographic, socioeconomic, and medical data were obtained from the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claims database. An age- and sex-matched cohort was established using a 1:3 ratio of 2,776,450 people with disabilities and 8,329,350 people without disabilities. Adult patients diagnosed with PC were subsequently selected from this cohort. Disabilities were categorized as physical, brain, communication, mental impairment, and affecting the major internal organs. RESULTS: The cohort included 12,402 patients with PC, with a significantly lower rate per 105 persons among people with disabilities than among people without disabilities (114.9 vs. 102.1, P < 0.0001). People with disabilities were more diagnosed PC at earlier age (P < 0.0091). Patients with disabilities had higher Charlson comorbidity index (1.47 vs. 2.00) and more below poverty line (5.8% vs. 13.3%) than those without disabilities. People with severe disabilities were diagnosed PC at earlier age, but less likely to undergo surgery (adjusted odds ratio 0.83, 95% confidence interval 0.77–0.96) or chemotherapy (0.81, 0.74–0.90) than those without disabilities. The overall and cancer specific mortality rates were higher in patients with disabilities than those without disabilities. This trend was more evident among patients with severe disabilities and in those with mental disorders. CONCLUSION: In Korea, people with disabilities generally have a lower rate of PC diagnosis, receive less intensive treatment, and have a lower survival rate than people without disabilities.