Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, MA, USA.
Ann Surg Oncol. 2009 Nov;16(11):2968-77. doi: 10.1245/s10434-009-0656-5. Epub 2009 Aug 11.
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.
与白人相比，黑人患胰腺腺癌的发病率更高，预后更差。识别胰腺癌治疗中的障碍可以解释生存差异，并为干预提供领域。
在美国监测、流行病学和最终结果登记处（1991-2002 年）中确定胰腺腺癌患者。从监测、流行病学和最终结果登记处-医疗保险数据库中获得治疗和结局数据。采用逻辑回归评估种族作为专家咨询/接受治疗的预测因子。比较 Kaplan-Meier 生存曲线。进行 Cox 比例风险分析，以估计调整患者和治疗特征后生存情况。
共确定了 13230 名白人患者（90%）和 1478 名黑人患者（10%）。按种族比较临床/病理因素。当我们按单因素分析比较白人和黑人时，黑人接受专家咨询的比例较低（P<.01），化疗（P<.01）和手术切除（P<.01）。在预测与癌症专家咨询的多变量分析中，黑人种族负向预测与医学肿瘤学家（调整后的优势比[OR].74，P<.01）、放射肿瘤学家（OR.75，P<.01）和外科医生（OR.71，P<.01）咨询。对于预测咨询后接受治疗的情况，黑人接受化疗（OR.59，P<.01）和手术切除（OR.79，P=.05）的可能性较低。Kaplan-Meier 生存曲线显示黑人的总体生存率更差（对数秩，P<.0001）。在评估生存的 Cox 比例风险模型中，黑人种族在调整手术切除和辅助治疗后不再与较差的生存独立相关（风险比，1.08；95%置信区间，.99-1.19）。
在胰腺癌症专家咨询和随后的治疗使用方面存在种族差异。由于接受治疗是缩小结果差异的基础，因此这些障碍是确保所有局部区域胰腺腺癌患者获得适当的专家转诊和随后治疗的离散干预点。
