Racial Disparities in the Diagnosis and Treatment of Pancreatic Cancer

Abstract

Introduction: Pancreatic cancer (PC) is the 4th leading cause of cancer death in the United States with very poor overall survival. African Americans (AA) belong to a subset of the population with the highest incidence of pancreatic cancer with incidence of 14.8 per 100,000 among AA men and 8.8 per 100,000 persons in the general population. Many population studies have found that AA and those with low socioeconomic status have an independent risk factor for pancreatic cancer mortality. This study aimed to investigate the degree of disparity in the diagnosis and treatment of pancreatic cancer among our urban minority patient population. Methods: This was an observational retrospective chart review of pancreatic cancer patients at the Brooklyn Hospital Center from 01/01/1990 to 11/30/2016, who were all of low socioeconomic status and predominantly African American ethnicity. Exclusion criteria were subjects less than 18 years of age, and those with incomplete medical documentation. Patients diagnosed with pancreatic cancer were assessed for race, stage of diagnosis, and treatment option received. Results: 103 patients were analyzed in which 76% (78/103) were AA and 24% (25/103) were non-AA. 45% (35/78) AA patients were diagnosed with pancreatic cancer at stage 4 with distant metastases. All other pancreatic cancers were found at earlier stages in a loco-regional area of the pancreas. Among non-AA, 48% (12/25) were detected at stage 4 with distant metastases. Patients were also analyzed for treatment disparity. AA diagnosed with pancreatic cancer received treatment 62% (48/78) of the time compared to non-AA who received treatment 70% (18/25) of the time with either surgery, chemotherapy, radiation, or surgery with adjuvant chemotherapy. Conclusion: Our study showed no major difference in the late stage detection of pancreatic cancer amongst AA and those of other races. In fact, AA patients had a slightly lower rate of late stage diagnosis. This data did not show much of a diagnostic disparity, which is different from documented studies in the literature. Our data however suggests a relative treatment disparity of about 8% between the two groups. Studies have shown that AA patients often refuse treatment for unknown reasons. Various socioeconomic or lifestyle causes could be reasons for treatment refusal. Our study showed that if low socioeconomic status populations have accessible quality healthcare, pancreatic cancer treatment disparities can be improved.