Disparities in Receipt of Neoadjuvant Chemotherapy in Patients with Borderline Resectable Pancreatic Cancer

Abstract

Introduction: Neoadjuvant chemotherapy (NT) in patients with borderline resectable pancreatic adenocarcinoma (BR) is associated with improved outcomes compared to surgery-first. Despite known benefit of NT, it remains unknown if socioeconomic disparities exist concerning administration of NT in patients with BR. Methods: Data from National Cancer Database identified patients with BR who underwent surgical resection. BR was defined as having venous or arterial involvement. Demographic factors of patients receiving NT was compared to surgery-first approach. Multivariable analysis was performed to identify characteristics associated with receipt of NT. Results: Of the 2,924 patient identified, 49.3% received NT. Age was associated with likelihood of receiving NT, with those ≥70 being less likely to receive NT compared to those ≤59 (OR 0.51, p<.001). Geographic location was associated with receipt of NT in the Northeast, Southwest, and West compared to treatment in Central Western United States (p<.05). Lastly, patients treated at community hospitals were significantly less likely to receive NT compared to those treated at academic institutions (OR 0.49, p<.001). Sex, race, insurance status, and education were not associated with likelihood of receiving NT (p>0.5). Those who received NT were more likely to be downstaged, have negative margin resection, and have a node negative disease compared to those who did not receive NT (p<.001). Discussion: This study reaffirms that use of NT in BR is associated with improved oncologic outcomes. Identification of existing disparities in the use of NT in patients with BR allows directed efforts to decrease disparities and increase access to NT.