Health insurance and pancreatic cancer.

Abstract

247 Background: Health insurance disparities affect the treatment and outcomes of many cancers and include differences in screening, surgical therapy and receipt of adjuvant therapy. The purpose of this study is to better identify the effect of health insurance on surgical therapy and overall survival (OS) in pancreatic adenocarcinoma (PDAC). Methods: 4564 patients diagnosed with PDAC between 2004 and 2013 from the Tennessee Cancer Registry were stratified into 5 groups: Private, Medicare, Military, Medicaid, and uninsured. Univariate analysis and multivariable (MV) logistic regression models were used to test the association of insurance with receipt of surgical therapy, adjuvant therapy, OS and cost. Results: Uninsured and Medicaid patients were more often black and presented with later stage disease. In patients with stage 1 and 2 disease, R0 resection rates, lymph node positivity and overall cost were similar across insurance groups. By MV analysis, Medicare and Military insurance patients were more likely to be resected (OR 2.52 and 3.30 respectively) with a trend for private insurance (OR 2.19) compared to the uninsured and Medicaid. There was no difference in the use of adjuvant chemotherapy (ACT). By Cox-proportional hazards regression, OS in resected patients amongst different insurance groups and race were similar (Table). Factors associated with decreased OS survival included increasing age, stage, lymph node status, and grade while the use of ACT, but not chemoradiation (ACRT), was associated with improved OS. Conclusions: Uninsured and Medicaid patients with PDAC present with later stage disease and are less likely to undergo resection. The use of adjuvant chemotherapy, OS and cost, however, are similar among insurance types. These results are in contrast to other cancers, suggesting that disparities in health insurance may play a smaller role in more aggressive cancers without effective screening. [Table: see text]