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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2009

01-11-2009 | Healthcare Policy and Outcomes

Racial Differences in Cancer Specialist Consultation, Treatment, and Outcomes for Locoregional Pancreatic Adenocarcinoma

Authors: Melissa M. Murphy, MD, MPH, Jessica P. Simons, MD, Sing Chau Ng, MS, Theodore P. McDade, MD, Jillian K. Smith, MD, MPH, Shimul A. Shah, MD, Zheng Zhou, MD, PhD, Craig C. Earle, MD, Jennifer F. Tseng, MD, MPH

Published in: Annals of Surgical Oncology | Issue 11/2009

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Abstract

Background

Blacks have a higher incidence of pancreatic adenocarcinoma and worse outcomes compared to whites. Identifying barriers in pancreatic cancer care may explain survival differences and provide areas for intervention.

Methods

Pancreatic adenocarcinoma patients were identified in the Surveillance, Epidemiology, and End Results Registry (1991–2002). Treatment and outcome data were obtained from the linked Surveillance, Epidemiology, and End Results Registry–Medicare databases. Logistic regression was used to assess race as a predictor of specialist consultation/receipt of therapy. Kaplan–Meier survival curves were compared. Cox proportional hazard analyses were performed to estimate survival after adjustment for patient and treatment characteristics.

Results

A total of 13,230 white patients (90%) and 1478 black patients (10%) were identified. Clinical/pathologic factors were compared by race. When we compared whites and blacks by univariate analyses, blacks had lower rates of specialist consultation (P < .01), chemotherapy (P < .01), and resection (P < .01). On multivariate analyses predicting consultation with a cancer specialist, black race negatively predicted consultation with a medical oncologist (adjusted odds ratio [AOR] .74, P < .01), radiation oncologist (AOR .75, P < .01), and surgeon (AOR .71, P < .01). For predicting receipt of therapy after consultation, blacks were less likely to undergo chemotherapy (AOR .59, P < .01) and resection (AOR .79, P = .05). Blacks had worse overall survival on Kaplan–Meier survival curves (log rank, P < .0001). On Cox proportional hazard modeling evaluating survival, black race was no longer independently associated with worse survival after adjustment for resection and adjuvant therapy (hazard ratio, 1.08; 95% confidence interval, .99–1.19).

Conclusions

Racial disparities exist in pancreatic cancer specialist consultation and subsequent therapy use. Because receipt of care is fundamental to reducing outcome discrepancies, these barriers serve as discrete intervention points to ensure all locoregional pancreatic adenocarcinoma patients receive appropriate specialist referral and subsequent therapy.
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Metadata
Title
Racial Differences in Cancer Specialist Consultation, Treatment, and Outcomes for Locoregional Pancreatic Adenocarcinoma
Authors
Melissa M. Murphy, MD, MPH
Jessica P. Simons, MD
Sing Chau Ng, MS
Theodore P. McDade, MD
Jillian K. Smith, MD, MPH
Shimul A. Shah, MD
Zheng Zhou, MD, PhD
Craig C. Earle, MD
Jennifer F. Tseng, MD, MPH
Publication date
01-11-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0656-5

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