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22-09-2023 | Original Article

Impact of Biopsy Attempts, Race, and Access on Time to Initiation of Treatment for Pancreatic Cancer

Authors: Riley P. Bohan, Andrea N. Riner, Kelly M. Herremans, Hanzhi Gao, Dominique D. Szymkiewicz, Ibrahim Nassour, Chris E. Forsmark, Steven J. Hughes

Published in: Journal of Gastrointestinal Surgery | Issue 11/2023

Abstract

Background

Biopsy of suspected pancreatic cancer (PDAC) in surgical candidates is informative however not always necessary. Biopsies impact treatment options as histological diagnosis are presently required for neo-adjuvant therapy, but not surgical resection. We explored the impact of pursuing tissue diagnosis by endoscopic ultrasound (EUS) biopsy on time to treatment in patients with resectable and borderline resectable PDAC.

Methods

A retrospective review of surgical patients with ultimately proven PDAC was performed (2011–2021). Milestone dates (cancer suspected, biopsy(ies), surgical or neo-adjuvant treatment) were collected. Mann–Whitney-Wilcoxon tests, Pearson’s chi-squared tests, Fisher’s exact tests, linear regressions, and Cox proportional hazard models were used for data analysis.

Results

Among 131 resectable and 58 borderline resectable patients, the borderline resectable group underwent more biopsies (1.2 vs 0.7, p < 0.0001), were more likely to undergo biopsy at tertiary care centers (67.2% vs 30.5%, p < 0.0001), and trended toward longer time to treatment (49 vs 44 days, p = 0.070). Significant increases in days to treatment were seen in patients with Black race (29 days, p = 0.0002) and Medicare insurance (22 days, p = 0.038) and no biopsies at a tertiary care center (10 days, p = 0.039). After adjusting for covariates, additional biopsies significantly delayed treatment (1 biopsy: 21 days, p = 0.0001; 2 biopsies: 44 days, p < 0.0001; 3 biopsies: 68 days, p < 0.0001).

Conclusions

EUS biopsy significantly impacts time between suspicion and treatment of PDAC. This may be exacerbated by clinical practices increasingly favoring neo-adjuvant therapy that necessitates biopsy-proven disease. Time to treatment may also be impacted by access to tertiary centers and racial disparities.

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Title: Impact of Biopsy Attempts, Race, and Access on Time to Initiation of Treatment for Pancreatic Cancer
Authors: Riley P. Bohan
Andrea N. Riner
Kelly M. Herremans
Hanzhi Gao
Dominique D. Szymkiewicz
Ibrahim Nassour
Chris E. Forsmark
Steven J. Hughes
Publication date: 22-09-2023
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 11/2023
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-022-05531-6

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Impact of Biopsy Attempts, Race, and Access on Time to Initiation of Treatment for Pancreatic Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote Webinar | Spotlight on Diet and Diabetes

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Abstract

Background

Methods

Results

Conclusions

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