Abstract
Age, sex, and racial/ethnic disparities exist, but are understudied in pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database to determine whether survival and treatment disparities persist after adjusting for demographic and clinical characteristics. Our study included PDAC patients diagnosed between 1992 and 2011. We used Cox regression to compare survival across age, sex, and race/ethnicity within early‐stage and late‐stage cancer subgroups, adjusting for marital status, urban location, socioeconomics, SEER region, comorbidities, stage, lymph node status, tumor location, tumor grade, diagnosis year, and treatment received. We used logistic regression to compare differences in treatment received across age, sex, and race/ethnicity. Among 20,896 patients, 84% were White, 9% Black, 5% Asian, and 2% Hispanic. Median age was 75; 56% were female and 53% had late‐stage cancer. Among early‐stage patients in the adjusted Cox model, older patient subgroups had worse survival compared with ages 66–69 (HR > 1.1, P < 0.01 for groups >69); no survival differences existed between sexes. Black (HR = 1.1, P = 0.01) and Hispanic (HR = 1.2, P < 0.01) patients had worse survival compared with White. Among late‐stage cancer patients, patients over age 84 had worse survival than those aged 66–69 (HR = 1.1, P < 0.01), and males (HR = 1.08, P < 0.01) had worse survival than females; there were no racial/ethnic differences. Older age and minority race/ethnicity were associated with lower likelihood of receiving chemotherapy, radiation, and/or surgery. Age and racial/ethnic disparities in survival outcomes and treatment received exist for PDAC patients; these disparities persist after adjusting for differences in demographic and clinical characteristics.
Highlights
Pancreatic cancer is the third leading cause of cancer death in the United States, and estimates suggest it will become the second leading cause of cancer death by 2030 due to an increased number of individuals older than age 65 as the baby boomer generation ages [1]
In 2017, over 53,000 new diagnoses of pancreatic cancer are expected in the United States, and projections expect over 43,000 deaths will be attributed to pancreatic cancer this year [2]
We categorized patients into four race/ethnicity groups (White, Black, Hispanic, Asian) using SEER variables; 62 patients coded as Native American and 58 patients coded as unknown race/ethnicity were excluded
Summary
Pancreatic cancer is the third leading cause of cancer death in the United States, and estimates suggest it will become the second leading cause of cancer death by 2030 due to an increased number of individuals older than age 65 as the baby boomer generation ages [1]. In 2017, over 53,000 new diagnoses of pancreatic cancer are expected in the United States, and projections expect over 43,000 deaths will be attributed to pancreatic cancer this year [2]. Studies suggest that older patients are typically less likely to receive treatment for their pancreatic cancer and to have worse survival outcomes [8]. These poor results may be related to older patients’ complex geriatric issues, such as medical comorbidities, poor nutrition, impaired physical and cognitive function, and limited social support [9,10,11,12,13]. There is a critical need for further research to characterize the impact of age on treatment received and survival outcomes in patients with pancreatic cancer in order to inform optimal management of the geriatric oncology population
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