Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma?
BACKGROUND
The objective of this study was to define the effects of socioeconomic status (SES) and other demographic variables on outcomes for patients with pancreatic adenocarcinoma.


METHODS
Florida cancer registry and inpatient hospital data were queried for pancreatic adenocarcinoma diagnosed from 1998 to 2002.


RESULTS
In total, 16,104 patients were identified. Low SES (LSES) patients were younger at diagnosis (P < .001) but presented with similar disease stage and tumor grade. LSES patients were less likely to receive surgical extirpation (16.5% vs 19.8%; P < .001), chemotherapy (30.7% vs 36.4%; P < .001), or radiotherapy (14.3% vs 16.9%; P = .003). Among surgical patients, 30-day mortality was significantly higher (5.1% vs 3.7%; P < .001) and overall median survival was significantly worse (5.0 months vs 6.2 months; P < .001) in the LSES cohorts. Although surgical patients who were treated at teaching facilities (TF) did significantly better; an increased 30-day surgical mortality (2.2% vs 1.3%; P < .001) and decreased median survival (5 months for poverty level >15% vs 6.2 months for poverty level <5%; P < .001) also were observed for patients of LSES. In a multivariate analysis that corrected for patient comorbidities, significant independent predictors of a poorer prognosis included LSES (hazard ratio [HR], 1.09); treatment at a non-TF (HR, 1.09); and failure to receive surgical extirpation (HR, 1.92), chemotherapy (HR 1.41), or radiation (HR 1.25).


CONCLUSIONS
Patients of LSES were less likely to receive surgical extirpation, chemotherapy, or radiation and had significantly higher perioperative and long-term mortality rates. A greater understanding of the barriers to providing optimal care and identifying means for improving successful delivery of therapies to the poor with pancreatic cancer are needed.
Cheung
Michael C
MC
DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA.
Yang
Relin
R
Byrne
Margaret M
MM
Solorzano
Carmen C
CC
Nakeeb
Attila
A
Koniaris
Leonidas G
LG
D000230:Adenocarcinoma / Q000191:economics / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D005431:Florida; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy*; D011203:Poverty; D012923:Social Class