title: Race does not impact pancreatic cancer treatment and survival in an equal access federal health care system.
abstract: BACKGROUND
  Black patients with pancreatic adenocarcinoma (PDAC) have been reported to undergo surgical resection less frequently and to have a shorter overall survival duration than white patients. We sought to determine whether disparities in clinical management and overall survival exist between black and white patients with PDAC treated in an equal access health care system.
  
  
  METHODS
  Using the Department of Defense (DoD) tumor registry database from 1993 to 2007, patient, tumor, and treatment factors were analyzed to compare rates of therapy and survival between black and white patients.
  
  
  RESULTS
  Of 1,008 patients with PDAC, 157 were black (15 %). Thirty-six percent of black and 37 % of white patients presented with locoregional disease (p = 0.85). Among those with locoregional cancers, the odds of black patients having received surgical resection (odds ratio [OR] 1.06, 95 % confidence interval [CI] 0.60-1.89), chemotherapy (OR 0.92, 95 % CI 0.49-1.73) and radiotherapy (OR 1.14, 95 % CI 0.61-2.10) were not different from those of whites. Among those with distant disease, the odds of having received palliative chemotherapy were also similar (OR 0.91, 95 % CI 0.55-1.51). Black and white patients with PDAC had a similar median overall survival. In a multivariate analysis, as compared to whites, black race was not associated with shorter overall survival.
  
  
  CONCLUSIONS
  We observed no disparities in either management or survival between white and black patients with PDAC treated in the DoD's equal access health care system. These data suggest that improving the access of minorities with PDAC to health care may reduce disparities in their oncologic outcomes.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, yubjang@yahoo.com.
authors.forename: Sukhyung
authors.initials: S
authors.lastname: Lee
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Reha
authors.forename: Ching-Wei D
authors.initials: CW
authors.lastname: Tzeng
authors.forename: Nader N
authors.initials: NN
authors.lastname: Massarweh
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hetz
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Katz
mesh_terms: D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*