Disparities in cancer outcomes across age, sex, and race/ethnicity among pancreatic cancer patients.

Abstract

e18071 Background: Age, sex, and racial/ethnic disparities exist for several malignancies, but these relationships are understudied in pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether these disparities persist in survival and treatment after adjusting for demographic, clinical, and treatment characteristics. Methods: Our study includes PDAC patients (pts) diagnosed from 1992-2011 in the SEER-Medicare database. We used Cox regression models to compare survival across age, sex, and race/ethnicity, stratified by non-metastatic and metastatic cancer. We used logistic regression to compare differences in chemotherapy, radiation, and surgery receipt across age, sex, and race/ethnicity. We adjusted for marital status, urban location, socioeconomic factors, SEER region, comorbidities, cancer stage, lymph node status, tumor location, tumor grade, diagnosis year, and chemotherapy, radiation, and/or surgery receipt. Results: Of 20,896 PDAC pts (median diagnosis age = 75 years; 56% female), 84% were White, 9% Black, 5% Asian, and 2% Hispanic; 53% had metastatic cancer. Among non-metastatic pts, adjusted Cox regression demonstrated that older pts had worse survival compared with younger pts (HR: ≥1.1 for all ages [reference = 66-69 years vs. 70-74, 75-79, 80-84, 85+], p < 0.01 for all); we found no survival differences between sexes. Black (HR: 1.1, p = 0.01) and Hispanic (HR: 1.2, p < 0.01) pts had worse survival compared to White pts. Among metastatic cancer pts, adjusted Cox regression demonstrated that older pts (HR: 1.1 for age 85+ [reference = 66-69 years], p < 0.01) had worse survival than younger pts, and males (HR: 1.1, p < 0.01) had worse survival than females. There were no racial/ethnic differences. There were disparities in treatment received; older age and minority race/ethnicity were associated with lower likelihood of receiving chemotherapy, radiation, and/or surgery. Conclusions: Age, sex, and racial/ethnic disparities in survival outcomes and treatment received exist for PDAC pts; these disparities persist after adjusting for differences in demographic, clinical, and treatment characteristics.