Disparities in guideline-compliant care for patients with pancreatic ductal adenocarcinoma at minority-versus non-minority-serving hospitals

Abstract

BackgroundWe examined disparities in guideline-compliant care at minority-serving hospitals (MSH) versus non-MSH among patients with localized or metastatic pancreatic adenocarcinoma (PDAC). MethodsPatients with PDAC were identified within the National Cancer Database (2004–2018). Guideline-compliant care was defined as surgery + chemotherapy ± radiation therapy for localized and chemotherapy for metastatic disease. Facilities in the top decile of minority patients treated were considered MSH. ResultsA total of 190,950 patients were identified and most (59.6%) had metastatic disease. Overall, 6.4% of patients with localized and 8.2% of patients with metastatic disease were treated at MSH.Patients treated at MSH were less likely to receive guideline-compliant care (localized: OR = 0.78, 95% CI: 0.67–0.91; metastatic: OR = 0.77, 95% CI: 0.67–0.88). Minority patients were less likely to receive guideline-compliant care at non-MSH (localized: OR = 0.71, 95% CI: 0.67–0.75; metastatic: OR = 0.85, 95% CI: 0.82–0.89) or MSH (localized: OR = 0.85, 95% CI: 0.74–0.98; metastatic: OR = 0.91, 95% CI: 0.82–0.99).Patients treated at non-MSH or MSH who received guideline-compliant care were more likely to have higher OS regardless of stage or race. ConclusionsMSH patients were less likely to receive guideline-compliant care and minority patients were less likely to receive guideline-compliant care regardless of MSH status. Guideline-compliant care was associated with improved OS.