Pancreatic Cancer Care Research Articles

Race/Ethnicity and Insurance: Main Factors Associated with Disparities in Receiving Guideline-concordant Care for Pancreatic Cancer in Texas

Race/Ethnicity and Insurance: Main Factors Associated with Disparities in Receiving Guideline-concordant Care for Pancreatic Cancer in Texas

Textbook oncologic outcome in pancreaticoduodenectomy: Do regionalization efforts make sense?

Few empiric studies evaluate the effects of regionalization on pancreatic cancer care. We queried the National Cancer Database to identify patients undergoing pancreaticoduodenectomy for clinical stage I/II pancreatic adenocarcinoma between 2006 and 2015. Facilities were categorized by annual pancreatectomy volume. Textbook oncologic outcome was defined as a margin negative resection, appropriate lymph node assessment, no prolonged hospitalization, no 30-day readmission, no 90-day mortality, and timely receipt of adjuvant chemotherapy. Multivariable regression adjusted for comorbid disease, pathologic stage, and facility characteristics was used to evaluate the relationship between facility volume and textbook outcome. Sixteen thousand six hundred and two patients underwent pancreaticoduodenectomy; 3566 (21.5%) had a textbook outcome. Operations performed at high volume centers increased each year (45.8% in 2006 to 64.2% in 2015, p < 0.001) as did textbook outcome rates (14.3%-26.2%, p < 0.001). Surgical volume was associated with textbook outcome. High volume centers demonstrated higher unadjusted rates of textbook outcome (25.4% vs. 11.8% p < 0.01) and increased adjusted odds of textbook outcome relative to low volume centers (odds ratio: 2.39, [2.02, 2.85], p < 0.001). Textbook outcome was associated with improved overall survival independent of volume. Regionalization of care for pancreaticoduodenectomy to high volume centers is ongoing and is associated with improved quality of care.

35P Increased sensitivity to olaparib by BRCA1/2 knockdown using a CRISPR/Cas9-mediated knock-in method in pancreatic cancer cell lines

Pancreatic cancer is one of the most incurable disease. About 80% of pancreatic adenocarcinoma are locally advanced at diagnosis or metastatic. Therefore, only 20% of patients undergo surgery and the majority have local relapse or metastasis. Chemotherapy regimens are used in adjuvant therapy with gemcitabine or FOLFIRINOX protocol, the standard of care for metastatic pancreatic cancer. Olaparib, a PARP inhibitor, is used as maintenance treatment in patient with metastatic pancreatic adenocarcinoma bearing a germline BRCA1/2 mutation.

Centralization of pancreatic cancer treatment within an integrated healthcare system improves overall survival

BackgroundHigher-volume centers for pancreatic cancer surgeries have been shown to have improved outcomes such as length of stay. We examined how centralization of pancreatic cancer care within a regional integrated healthcare system improves overall survival. MethodsWe conducted a retrospective study of 1621 patients treated for pancreatic cancer from February 2010 to December 2018. Care was consolidated into 4 Centers of Excellence (COE) in surgery, medical oncology, and other specialties. Descriptive statistics, bivariate analysis, Chi-square tests, and Kaplan–Meier analysis were performed. ResultsNeoadjuvant chemotherapy use rose from 10% to 31% (p < .001). The median overall survival (OS) improved by 3 months after centralization (p < .001), but this did not reach significance on multivariate analysis. ConclusionsOur results suggest that in a large integrated healthcare system, centralization improves overall survival and neoadjuvant therapy utilization for pancreatic cancer patients.

Pancreas cancer trials for early stage disease: Surgeons leading therapeutic cooperative group trials

Surgeon-led clinical trials have defined the standard of care for locoregional pancreatic cancer to date. The infrastructure and collaborative nature of cooperative oncology groups offer many advantages, such as providing an ideal mechanism through which multidisciplinary pancreatic cancer trials are performed. As key members of the treatment team, surgeons bring experience and expertise to the design of surgical and multidisciplinary trials and are uniquely poised to be leaders of future pancreatic cancer trials.

Global, regional, and national survey on the burden and quality of care of pancreatic cancer: a systematic analysis for the Global Burden of Disease study 1990–2017

BackgroundPancreatic cancer (PC) is among the most lethal cancers worldwide, and the quality of care provided to PC patients is a vital public health concern. We aimed to investigate the quality of care of PC globally and to report its current burden. MethodsThe Quality of Care Index (QCI) was achieved by performing a Principal Component Analysis utilizing the results of the GBD study 2017. The QCI was defined as a range between 0 and 100, in which higher QCIs show higher quality of care. Possible gender- and age-related inequalities in terms of QCI were explored based on WHO world regions and the sociodemographic index (SDI). ResultsIn 2017, Japan had the highest QCI among all countries (QCI = 99/100), followed by Australia (QCI = 83/100) and the United States (QCI = 76/100). In Japan and Australia, males and females had almost the same QCIs in 2017, while in the United States, females had lower QCIs than males. In contrast to these high-QCI nations, African countries had the lowest QCIs in 2017. Besides, QCI increased by SDI, and high-SDI regions had the highest QCIs. Regarding patients’ age, elderly cases had higher QCIs than younger patients globally and in high-SDI regions. ConclusionThis study provides clinicians and health authorities with a wider vision around the quality of care of PC worldwide and highlights the existing disparities. This could help them investigate possible effective strategies to improve the quality of care in regions with lower QCIs and higher gender- and age-related inequities.

1485P Identification of novel protein biomarkers for FOLFIRINOX-based chemotherapy response in advanced pancreatic adenocarcinoma using patient omics and Bayesian AI

FOLFIRINOX-based chemotherapy regimens are considered standard of care for advanced pancreatic cancer and treatment options become limited once patients are refractory to this initial treatment. The overwhelming risk of standard of care treatment failure for advanced pancreatic cancer highlights the need to identify biomarkers predictive of treatment-failure to improve clinical outcomes and provide alternative options.

ASO Author Reflections: The Challenge of Achieving High-Quality, Equitable Care for Pancreatic Cancer: Might Medicaid Expansion Be a Piece of the Puzzle?

ASO Author Reflections: The Challenge of Achieving High-Quality, Equitable Care for Pancreatic Cancer: Might Medicaid Expansion Be a Piece of the Puzzle?

Providing Appropriate Pancreatic Cancer Care for People Experiencing Homelessness: A Surgical Perspective.

People experiencing homelessness are particularly vulnerable when diagnosed with pancreatic cancer. Patients with lower socioeconomic status have worse outcomes from pancreatic cancer as the result of disparities in access to treatment and barriers to navigation of the health care system. Patients with lower socioeconomic status, or who are vulnerably housed, are less likely to receive surgical treatment even when it is recommended by National Comprehensive Cancer Network guidelines. This disparity in access to surgical care explains much of the gap in pancreatic cancer outcomes. There are many factors that contribute to this disparity in surgical management of pancreatic cancer in people experiencing homelessness. These include a lack of reliable transportation, feeling unwelcome in the medical setting, a lack of primary care and health insurance, and implicit biases of health care providers, including racial bias. Solutions that focus on rectifying these problems include utilizing patient navigators, addressing implicit biases of all health care providers and staff, creating an environment that caters to the needs of patients experiencing homelessness, and improving their access to insurance and regional support networks. Implementing these potential solutions all the way from the individual provider to national safety nets could improve outcomes for patients with pancreatic cancer who are experiencing homelessness.

Clinicians’ perspectives on strategies to improve cross-institutional collaboration and coordination of pancreatic cancer care for rural patients.

e13532 Background: Rural pancreatic cancer patients often lack access to high-volume pancreatic cancer specialists. This lack of access can result in fragmented cancer care—when patients receive care at multiple institutions—and necessitates that specialists engage in cross-institutional collaboration. In the context of fragmented pancreatic cancer care, the strategies specialists use to facilitate collaboration across institutions are poorly understood. Methods: We conducted semi-structured interviews with cancer specialists (medical, surgical, and radiation oncologists) from a high-volume pancreas cancer center (n = 9) and rural community cancer centers (n = 11) to examine specialists’ coordination practices related to treating and co-managing pancreatic cancer patients across their respective institutions. Using qualitative methods, two of the co-authors independently coded the interview transcripts to identify themes related to cross-institutional coordination practices, noting improvement opportunities and facilitative strategies. Results: Cancer specialists described multiple practices to coordinate cross-institutional care including one-on-one phone calls and using a shared electronic medical record or secure email to exchange clinical notes. In recognizing the limitations of these practices, specialists acknowledged the need to develop and implement communication systems that could facilitate real-time discussions and information sharing between high-volume and rural specialists to coordinate diagnostic and treatment plans. Cross-institutional virtual tumor boards were viewed as a potentially useful approach to foster shared clinical decision-making and treatment plan development across institutions, but specialists perceived that logistical, institutional, and technological challenges could limit the use of this approach. Regardless, specialists indicated that cross-institutional virtual tumor boards could help disseminate treatment recommendations as well as identify barriers to care for mutually-shared rural cancer patients. Specialists also indicated that a dedicated patient navigator could help facilitate cross-institutional coordination by bridging communication between specialists while also assisting cancer patients with issues related to housing, transportation, scheduling, and treatment finances. Conclusions: It is important for cancer specialists treating rural cancer patients to have strategies that support efficient communication and decision-making. Cross-institutional virtual tumor boards and dedicated patient navigators are two such strategies that may help facilitate collaboration between high-volume and rural cancer specialists. Future research should examine the impact of these strategies on patients receiving cancer care at multiple institutions.

Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis.

e18567 Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P &lt; 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P &lt; 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P &gt; 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P &gt; 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P &gt; 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P &gt; 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P &gt; 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P &gt; 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P &gt; 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.

Real-world experience of pancreatic cancer molecular profiling in a tertiary center.

e22526 Background: NCCN has recommended universal genetic testing of pancreatic cancer. Liquid biopsies have been approved by the FDA to facilitate detection of targetable mutations in various solid tumors. Methods: To investigate how oncologists follow NCCN guidelines and utilize liquid biopsies in pancreatic cancer, we retrospectively queried patient records from 7/2016 to 6/2020 in our institutional system. Those retrieved but with pancreatic cancer care from other 2 local institutions are also included. Demographics, cancer stage on diagnosis, year of diagnosis, molecular profiling (MP) and treatment setting (community vs academic) are recorded and analyzed. Results: A total of 500 pancreatic cancer patient records were identified. Of these, 234 patients were excluded due to incomplete records. Among the remaining 266 patients, 113 (42.5%) had MP performed. Younger patients and those treated at an academic setting were more likely to have MP (P= 0.0051 and 0.0010 respectively). The trend of increased utilization of MP over the years is also statistically significant (p&lt; 0.0001). Gender, ethnicity or stage on diagnosis are not statistically significant between groups. (Table). Conclusions: MP is being increasingly utilized. However, more awareness is needed among oncologists, especially those who practice in the community setting.[Table: see text]

An internal review of rates of palliative medicine referral for patients with advanced pancreatic cancer.

e16245 Background: Patients diagnosed with advanced pancreatic cancer face many challenges in addition to symptom burden including psychological stressors and often the need for supportive care at home. In recent years, both clinical trials and retrospective reviews have confirmed the benefits of early integration of palliative care services such as improved quality of life and reduced symptom intensity. The American College of Clinical Oncology recommends patients with advanced cancer receive directed palliative care services early after diagnosis and in concurrence with active treatment. While the benefit of palliative care services is clear, the best way to integrate palliative services has not been determined. Our project aims to review the rates of palliative care consultation in patients with advanced pancreatic cancer intending to improve patient outcomes. Methods: We retrospectively reviewed the electronic medical records of all patients diagnosed with pancreatic cancer at Allegheny General Hospital diagnosed between 2009-2020. Summary statistics are presented as percentages for categorical data and median with interquartile range for quantitative data. Results: Of the 171 patients reviewed, 121 competed all treatment and evaluation within our health network. Median age was 63 years (IQR 40-91 years); 55 patients (45%) were male. The majority were white (88%). At the time of diagnosis, 28% of our patients had stage IV disease and 19.8% of patients with stage IV disease had documented palliative care referrals. Eight patients had pain documented at diagnosis, six patients underwent celiac plexus neurolysis, 31 underwent palliative radiation and 43 patients had documented opiate use. Of the 6 patients who underwent celiac plexus neurolysis, only 4 documented pain at 6-month follow-up. Of the 31 patients who underwent palliative radiation, 6 documented pain at 6-month follow-up. Conclusions: Palliative care is an integral part of usual care for pancreatic cancer. Our analysis showed that palliative care is underutilized in our hospital with only 19.8% of patients having documented palliative care visits. While patients may refuse palliative care consult, other contributing factors are likely the lack of access or lack of early involvement of palliative care team members. Integration of palliative care has been proven repeatedly to improve quality of life in patients diagnosed with advanced pancreatic cancer. We aim to improve palliative care integration in out patients’ care by adding a hard stop to electronic medical records to remind physicians to offer palliaitive care to the patients, in addition to arranging medical grand rounds and various lectures to increase awareness of the importance of palliative care in this setting.

Index Symptoms and Prognosis Awareness of Patients With Pancreatic Cancer: A Multi-Site Palliative Care Collaborative.

Pancreatic cancer has a poor 5-year survival and carries significant morbidity. Pain is a commonly studied symptom in pancreatic cancer; however, few studies examine the frequency of multiple patient-reported symptoms. Our aim is to ascertain patient-reported symptom burden at initial consultation with a palliative care provider and compare patient prognostic awareness to provider estimation of prognosis. Data were extracted from the standardized Quality Data Collection Tool (QDACT). Adults with pancreatic cancer seen by a palliative care provider were included. Descriptive statistics were used to describe demographic features, symptom prevalence and burden, as well as assess patient prognosis awareness defined by congruence or incongruence with provider estimated prognosis. 285 patients were included in our analysis. The average age was 68 years (SD: 12.4), 87.2% were white, 50% male. The mean number of moderate/severe symptoms was 2.6 (SD: 2) out of 9 symptoms. Tiredness (66.7%), appetite (64.5%) and pain (46.2%) had the highest rates of moderate/severe symptom burden. Patients with a prognosis of 1-6 months had the lowest proportion of congruence with provider estimation (56.5%). Our study suggests targets to improve patient-centered care of pancreatic cancer. Patients commonly have multiple symptoms that are moderate/severe at time of palliative care referral. While pain has been well-reported, tiredness and decreased appetite are more prevalent at initial visit. This emphasizes the importance of assessing multiple symptoms and working closely with palliative care for early referral. Overall, one third of patient prognosis estimates differed from the provider assessment of prognosis. Our data support the importance of early referral to palliative care to manage symptoms and better prepare patients for end-of-life care.

The disconcerting differences in pancreatic cancer care among races

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

Regionalization of pancreatic cancer treatment within an integrated healthcare system

Presenter: Diana Hsu MD | University of California, San Francisco Background: Studies have shown that pancreaticoduodenectomies performed at higher volume centers result in decreased mortality, length of stay, operating time, and cost compared to those performed at lower volume centers. Kaiser Permanente Northern California (KPNC) implemented regionalization of pancreatic cancer care to Centers of Excellence (CoE) within its integrated healthcare system. This study examines the survival outcomes after the regionalization of care. Methods: A retrospective chart review of 1621 patients undergoing pancreatic cancer treatment from February 2010 and December 2018 was performed. The transitions from 21 hospitals to 4 Centers of Excellence (CoE) included creating high volume pancreatic surgery centers (>25 pancreatic resections per year) and designated specialties, such as medical oncology, radiology, radiation oncology, and pathology. Descriptive statistics were performed, followed by bivariate analysis to assess differences in characteristics according to either the independent or dependent variables. Given that all variables assessed were categorical, Chi squared tests were used to determine differences of statistical significance. Unadjusted and adjusted survival analyses were performed using Kaplan–Meier. Cox proportional hazard regression models were used to determine the association between race and ethnicity and the primary outcome (overall survival in months). All statistical analyses were performed by SPSS version 22. Results: There was no difference in baseline demographics among patients undergoing pancreatic cancer treatment pre and post-regionalization. However, there was a statistically significant difference in pre and post-regionalization number of patients who had 16 or more lymph nodes sampled, 142 (44%) and 219 (69%), respectively (p<.001). There was also an increase in neoadjuvant chemotherapy utilization from 10% to 31%, pre and post-regionalization. The median overall survival (OS) pre and post-regionalization was 11 and 14 months, respectively (p<.001). (Fig 1) Median follow up of patients was 32 months. Conclusion: Regionalization of pancreatic cancer care at KPNC, an integrated hospital system, resulted in improvements in surgical quality outcomes, such as adequate lymph node sampling. Our multidisciplinary approach to CoE encompasses standardization and performance improvements in oncology, radiology, pathology, as well as surgery. The results suggest that regionalization of care in a large integrated healthcare system improves overall survival for patients undergoing pancreatic cancer treatment.

Abstract PO-105: Treatment inequity: Examining the influence of race and ethnicity, sex, and insurance on pancreatic cancer care

Abstract Background: Socioeconomic-based treatment disparities are well-documented in pancreatic cancer in the United States. Studies have found treatment disparities by race and ethnicity, insurance, income, sex, and age. We examined 14 years of pancreatic cancer intended first course treatment data in a Midwestern state to identify state-specific disparities. Methods: Data from 8,416 pancreatic cancer patients aged over 18 diagnosed with adenocarcinoma, NOS or infiltrating duct carcinoma, NOS from 2004 to 2017 were obtained from the Wisconsin Cancer Reporting System. Adjusted logistic regression was performed to describe the association between patient characteristics and intended first course treatment. Treatment was defined as radiation, chemotherapy, or surgery, alone or in combination. The analysis was completed for all patients. It was repeated for the subset of 5,005 Medicare Patients to examine disparities by Medicare subtype. Race/ethnicity, sex, rurality, and insurance were factors of interest. Age and stage at diagnosis were included as confounders. Results: The mean overall survival of the 8,416 patients was 9.9 months. 70.5% of patients received treatment. 53% of patients were diagnosed with metastatic disease. The adjusted odds ratio of receiving treatment was 0.52 (0.41-0.65) for Non-Hispanic Black patients, 0.46 (0.24- 0.88) for Non-Hispanic Asian patients, and 0.46 (0.22-0.94) for patients categorized as ‘Other’ race/ethnicity compared to Non-Hispanic White patients. The adjusted odds ratio of receiving treatment was 0.90 (0.81-1.00) for female compared to male patients. The adjusted odds ratio of receiving treatment was 0.40 (0.29-0.54) for Medicaid patients, 0.80 (0.66-0.97) for Medicare patients, 0.44 (0.32-0.61) for Military patients, 0.18 (0.09-0.35) for Not Insured patients, and 0.24 (0.15-0.39) for Self Pay patients compared to Private Insurance patients. Among the 5,005 Medicare patients, the adjusted odds ratio of receiving treatment was 0.49 (0.35-0.68) for Non-Hispanic Black compared to Non-Hispanic White patients, 0.86 (0.76-0.98) for female compared to male patients, and 0.45 (0.33-0.62) for Medicare with Medicaid eligibility compared to Medicare, NOS patients. The adjusted odds ratio of receiving treatment was 1.42 (1.19-1.69) for Medicare patients with a supplement, NOS, 1.36 (1.11-1.66) for Medicare patients where Medicare was administered via a managed care plan, and 1.38 (1.13-1.70) for Medicare patients with a private supplement compared to Medicare, NOS patients. Rurality was not associated with treatment in either model. Conclusions: Significant race/ethnicity, sex, and insurance-based treatment disparities exist amongst Wisconsin pancreatic cancer patients. Future studies should investigate the contribution of social, clinician, and healthcare system factors that impact inequitable access to, inconsistent presentation of, and underutilization of treatment for people of color, women, and publicly insured or uninsured patients. Citation Format: Andrea M. Schiefelbein, Amy K. Taylor, Yana Puckett, Jienian Zhang, John K. Krebsbach, John M. Hampton, Amy Trentham- Dietz, Melissa C. Skala, Sharon M. Weber, John M. Eason, Noelle K. LoConte. Treatment inequity: Examining the influence of race and ethnicity, sex, and insurance on pancreatic cancer care [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-105.

TSPO-targeted PET and Optical Probes for the Detection and Localization of Premalignant and Malignant Pancreatic Lesions.

Pancreatic cancer is among the most aggressive malignancies and is rarely discovered early. However, pancreatic "incidentalomas," particularly cysts, are frequently identified in asymptomatic patients through anatomic imaging for unrelated causes. Accurate determination of the malignant potential of cystic lesions could lead to life-saving surgery or spare patients with indolent disease undue risk. Current risk assessment of pancreatic cysts requires invasive sampling, with attendant morbidity and sampling errors. Here, we sought to identify imaging biomarkers of high-risk pancreatic cancer precursor lesions. Translocator protein (TSPO) expression, which is associated with cholesterol metabolism, was evaluated in premalignant and pancreatic cancer lesions from human and genetically engineered mouse (GEM) tissues. In vivo imaging was performed with [18F]V-1008, a TSPO-targeted PET agent, in two GEM models. For image-guided surgery (IGS), V-1520, a TSPO ligand for near-IR optical imaging based upon the V-1008 pharmacophore, was developed and evaluated. TSPO was highly expressed in human and murine pancreatic cancer. Notably, TSPO expression was associated with high-grade, premalignant intraductal papillary mucinous neoplasms (IPMNs) and pancreatic intraepithelial neoplasia (PanIN) lesions. In GEM models, [18F]V-1008 exhibited robust uptake in early pancreatic cancer, detectable by PET. Furthermore, V-1520 localized to premalignant pancreatic lesions and advanced tumors enabling real-time IGS. We anticipate that combined TSPO PET/IGS represents a translational approach for precision pancreatic cancer care through discrimination of high-risk indeterminate lesions and actionable surgery.

Traveling for Pancreatic Cancer Care Is Worth the Trip.

Centralized care for patients with pancreatic cancer is associated with longer survival. We hypothesized that increased travel distance from home is associated with increased survival for pancreatic cancer patients. The National Cancer Database user file for all pancreatic cancer patients was investigated from 2004 through 2015. Distance from the patients' zip code to the treating facility was determined. Survival was investigated using the Kaplan-Meier method. Cox hazard ratios (CoxHRs) were determined based on stage of disease, distance traveled for care, and clinical factors. 340780 patients were identified. In the average age of 68 ± 12years, 51% were male and 83% were Caucasian. For all stages of cancer, longer survival was associated with traveling farther (P < .001). The survival advantage was longer for Caucasians than African Americans (3.7months vs. 2.6months, P < .001) Travel was associated with a 13% decrease in risk of death (P < .001). Even controlling for the pathologic stage, traveling farther was associated with decreased risk of death (CoxHR = .91, P < .001). Traveling for care is associated with improved survival for pancreatic cancer patients. While a selection bias may exist, the fact that all stages of patients investigated benefited suggests that this is a real phenomenon.

Does Health Insurance Protect Against Financial Catastrophe in Pancreatic Cancer Care? A Retrospective Review of Patients Undergoing Surgical Resection for Pancreatic Cancer at the University of Alabama

Does Health Insurance Protect Against Financial Catastrophe in Pancreatic Cancer Care? A Retrospective Review of Patients Undergoing Surgical Resection for Pancreatic Cancer at the University of Alabama