Abstract
BackgroundPancreatic cancer is projected to become the second leading cause of cancer‐related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as first‐line therapy for biliary decompression in pancreatic cancer. The aim of our study was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer.MethodsRetrospective cohort study using the US Surveillance, Epidemiology, and End Results (SEER)‐Medicare database to identify patients diagnosed with pancreatic cancer from 2003‐2013. The primary outcome was receipt of ERCP, with or without stent placement, vs any non‐ERCP biliary intervention.ResultsOf the 36 619 patients with pancreatic cancer, 37.5% (n = 13 719) underwent an ERCP, percutaneous drainage, or surgical biliary bypass. The most common biliary intervention (82.6%) was ERCP. After adjusting for tumor location and stage, Blacks were significantly less likely to receive ERCP than Whites (aOR 0.84, 95% CI 0.72, 0.97) and more likely to receive percutaneous transhepatic biliary drainage (PTBD) (aOR 1.38, 95% CI 1.14, 1.66). Patients in the Southeast and the West were more likely to receive ERCP than those in the Northeast (Southeast aOR 1.21, 95% CI 1.04, 1.40; West aOR 1.16, 95% CI 1.01, 1.32).ConclusionRacial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients.
Highlights
Pancreatic cancer is one of the deadliest malignant neoplasms, with a five-year survival of only 7%.1 The incidence of pancreatic cancer has increased over the past decade, and it is projected to become the second leading cause of cancer-related deaths by 2030 in the United States.[2,3] The poor prognosis of pancreatic cancer can be attributed in part to the large proportion of patients that present at an advanced stage which precludes surgical resection.Biliary decompression is often required in advanced pancreatic cancer for symptomatic relief and to allow neoadjuvant chemotherapy in patients with borderline resectable tumors.[4,5] Endoscopic retrograde cholangiopancreatography (ERCP) plays a critical role in the management of obstructive jaundice among pancreatic cancer patients
Black pancreatic cancer patients were less likely to receive an ERCP, which is the preferred route of biliary decompression, and more likely to receive percutaneous transhepatic biliary drainage (PTBD)
ERCP is recommended as the initial biliary decompressive intervention for patients who present with biliary obstruction due to a pancreatic head mass.[20]
Summary
The incidence of pancreatic cancer has increased over the past decade, and it is projected to become the second leading cause of cancer-related deaths by 2030 in the United States.[2,3] The poor prognosis of pancreatic cancer can be attributed in part to the large proportion of patients that present at an advanced stage which precludes surgical resection. Biliary decompression is often required in advanced pancreatic cancer for symptomatic relief and to allow neoadjuvant chemotherapy in patients with borderline resectable tumors.[4,5] Endoscopic retrograde cholangiopancreatography (ERCP) plays a critical role in the management of obstructive jaundice among pancreatic cancer patients. Pancreatic cancer is projected to become the second leading cause of cancer-related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as first-line therapy for biliary decompression in pancreatic cancer. Our study’s aim was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer
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