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

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Abstract
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. 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. 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). 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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