Open AccessDisparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer
Author(s) -
Nipp Ryan,
Tramontano Angela C.,
Kong Chung Yin,
Pandharipande Pari,
Dowling Emily C.,
Schrag Deborah,
Hur Chin
Publication year - 2018
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1277
Subject(s) - medicine , proportional hazards model , ethnic group , logistic regression , stage (stratigraphy) , demography , epidemiology , marital status , pancreatic cancer , cancer , surveillance, epidemiology, and end results , oncology , cancer registry , population , biology , paleontology , environmental health , sociology , anthropology
Age, sex, and racial/ethnic disparities exist, but are understudied in pancreatic adenocarcinoma ( PDAC ). We used the Surveillance, Epidemiology, and End Results ( SEER )–Medicare linked database to determine whether survival and treatment disparities persist after adjusting for demographic and clinical characteristics. Our study included PDAC patients diagnosed between 1992 and 2011. We used Cox regression to compare survival across age, sex, and race/ethnicity within early‐stage and late‐stage cancer subgroups, adjusting for marital status, urban location, socioeconomics, SEER region, comorbidities, stage, lymph node status, tumor location, tumor grade, diagnosis year, and treatment received. We used logistic regression to compare differences in treatment received across age, sex, and race/ethnicity. Among 20,896 patients, 84% were White, 9% Black, 5% Asian, and 2% Hispanic. Median age was 75; 56% were female and 53% had late‐stage cancer. Among early‐stage patients in the adjusted Cox model, older patient subgroups had worse survival compared with ages 66–69 ( HR > 1.1, P < 0.01 for groups >69); no survival differences existed between sexes. Black ( HR = 1.1, P = 0.01) and Hispanic ( HR = 1.2, P < 0.01) patients had worse survival compared with White. Among late‐stage cancer patients, patients over age 84 had worse survival than those aged 66–69 ( HR = 1.1, P < 0.01), and males ( HR = 1.08, P < 0.01) had worse survival than females; there were no racial/ethnic differences. Older age and minority race/ethnicity were associated with lower likelihood of receiving chemotherapy, radiation, and/or surgery. Age and racial/ethnic disparities in survival outcomes and treatment received exist for PDAC patients; these disparities persist after adjusting for differences in demographic and clinical characteristics.