The disconcerting differences in pancreatic cancer care among races

Abstract

Presenter: Catalina Mosquera MD | Virginia Commonwealth University Massey Cancer Center Background: Racial disparities in surgical access and post-operative outcomes following pancreatic resection for pancreatic cancer, continues to be a concern and target for improvement. Unfortunately, studies that investigate the independent impact of race in cancer treatment and post-operative outcomes are lacking. The goal of our study was to investigate the impact of race on oncologic treatment and surgical outcomes following pancreatico-duodenectomy for pancreatic adenocarcinoma using a large national database. We hypothesize that the non-white patients will have lower rates of adjuvant therapy and worse postoperative outcomes. Methods: A retrospective survey was performed utilizing the National-Surgical-Quality-Improvement-Program (NSQIP), data from 2014-2019 for patients undergoing pancreatico-duodenectomy for pancreatic adenocarcinoma. Preoperative characteristics, tumor factors and postoperative outcomes were compared between race groups in all patients. Distributions of each race in the database was calculated relative to the estimated number of patients with resectable pancreatic cancer in the US. Multivariate logistic regression was conducted to assess the independent impact of race on outcomes following pancreatico-duodenectomy. Results: A total of 6562 patients undergoing pancreatic resection for pancreatic adenocarcinoma were evaluated. There was similar gender distribution (52% male) with a median age of 66 years of age. Majority of the patients were classified as white 84%, followed by African American 7.9%, Asian 4.5% and Hispanic 3.0%. Only 20% were categorized as ASA 1-2. In terms of tumor characteristics, 58% of patients had T3 disease followed by T2 in 25%, and T1 in 12% of the cases. Nodal positivity was common (65%). Less than half of the patients received chemotherapy (39.6%) and only a quarter received radiation therapy (16.9%). Regarding outcomes, Majority of patients were discharged home (87.7%) There was a 30-day readmission rate of 14.7% and a 30-day mortality rate of 1.7%. On univariate analysis Asians and Hispanics were healthier compared to their counterparts (ASA1-2 30% and 23% vs. 19.1% and 14.3%, p<0.05). There were no significant differences in tumor characteristics between races. Asians and Hispanics were less likely to receive chemotherapy or radiation therapy compared to African Americans and whites [(chemotherapy: Asian:31.2%, Hispanic 30.4%, African American 41.4% and white 40.2%), (Radiation therapy: Asian: 11.1%, Hispanic 12.3%, African American 19.7% and white 17%, p<0.008)]. Disparities played a significant role in postoperative complications; African Americans were more likely to develop sepsis and return to the operating room (p<0.005) whereas Asians and Hispanics were more likely to require transfusions, have a prolonged ventilator wean and longer hospital stay. Discharge destination, readmissions and 30 day mortality were similar between racial groups. On multivariate analysis race persisted as an independent predictor of oncologic care and postoperative complications. Conclusion: In this large national-level surgical database, a significant interaction between race and postoperative outcomes was found. Disparities were noted in access to oncologic therapy. Race was independently associated with postoperative complications