The Impact of Treatment at Minority-serving Hospitals on Outcomes for Pancreatic Cancer

Abstract

Introduction: Healthcare for racial minorities is densely concentrated within a small subset of hospitals in the United States. Understanding outcomes at these minority-serving hospitals (MSH) is highly relevant to the study of racial disparities in cancer care. Our aim was to identify the impact of receiving treatment at an MSH on overall survival (OS) and on receipt of definitive treatment for minority patients with pancreatic cancer. Methods: Using the National Cancer Database, we identified all patients diagnosed with non-metastatic biopsy-proven pancreatic adenocarcinoma between 2004-2014. MSH were defined as institutions in the top decile of proportion of Black and Hispanic patients within the cohort. Univariate and multivariate analyses were performed to assess the influence of patient- and hospital-level factors on OS and receipt of definitive treatment for pancreatic cancer. Results: 21,452 Black and Hispanic patients were included. 4,103(19.1%) were treated at MSH. There was no difference in the proportion of patients undergoing resection(p=0.353). On adjusted analysis, there was no difference in OS for patients treated at MSH versus those treated at non-MSH (Hazard Ratio[HR]=0.99, 95%Confidence Interval[CI]:0.95–1.04;p=0.79). Significant factors associated with a decreased likelihood of death were receipt of surgery (HR 0.44, 95%CI:0.42-0.45), administration of systemic chemotherapy (HR 0.90, 95%CI:0.86-0.94), and high income (HR 0.86, 95%CI:0.80-0.92). Conclusions: For Black and Hispanic patients with non-metastatic pancreatic cancer, there was no difference in OS associated with receipt of treatment at MSH, despite differences in patient demographics and hospital characteristics. Further study is required to identify sources and impact of disparities in cancer care.