Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Division of Hematology and Oncology, Department of Medicine, University Hospitals Seidman Cancer Center, Case Western Reserve University Cleveland, OH, USA.
HPB (Oxford). 2023 Dec;25(12):1502-1512. doi: 10.1016/j.hpb.2023.07.903. Epub 2023 Jul 27.
We examined disparities in guideline-compliant care at minority-serving hospitals (MSH) versus non-MSH among patients with localized or metastatic pancreatic adenocarcinoma (PDAC).
Patients with PDAC were identified within the National Cancer Database (2004-2018). Guideline-compliant care was defined as surgery + chemotherapy ± radiation therapy for localized and chemotherapy for metastatic disease. Facilities in the top decile of minority patients treated were considered MSH.
A total of 190,950 patients were identified and most (59.6%) had metastatic disease. Overall, 6.4% of patients with localized and 8.2% of patients with metastatic disease were treated at MSH. Patients treated at MSH were less likely to receive guideline-compliant care (localized: OR = 0.78, 95% CI: 0.67-0.91; metastatic: OR = 0.77, 95% CI: 0.67-0.88). Minority patients were less likely to receive guideline-compliant care at non-MSH (localized: OR = 0.71, 95% CI: 0.67-0.75; metastatic: OR = 0.85, 95% CI: 0.82-0.89) or MSH (localized: OR = 0.85, 95% CI: 0.74-0.98; metastatic: OR = 0.91, 95% CI: 0.82-0.99). Patients treated at non-MSH or MSH who received guideline-compliant care were more likely to have higher OS regardless of stage or race.
MSH patients were less likely to receive guideline-compliant care and minority patients were less likely to receive guideline-compliant care regardless of MSH status. Guideline-compliant care was associated with improved OS.
我们研究了在局部或转移性胰腺腺癌（PDAC）患者中，少数民族服务医院（MSH）与非 MSH 之间符合指南的护理差异。
在国家癌症数据库（2004-2018 年）中确定 PDAC 患者。符合指南的护理定义为局部手术+化疗±放疗和转移性疾病的化疗。接受少数民族患者治疗最多的前十分之一的设施被认为是 MSH。
共确定了 190950 名患者，其中大多数（59.6%）患有转移性疾病。总体而言，6.4%的局部患者和 8.2%的转移性疾病患者在 MSH 接受治疗。在 MSH 接受治疗的患者接受符合指南的护理的可能性较低（局部：OR=0.78，95%CI：0.67-0.91；转移性：OR=0.77，95%CI：0.67-0.88）。非 MSH（局部：OR=0.71，95%CI：0.67-0.75；转移性：OR=0.85，95%CI：0.82-0.89）或 MSH（局部：OR=0.85，95%CI：0.74-0.98；转移性：OR=0.91，95%CI：0.82-0.99）接受治疗的少数民族患者不太可能接受符合指南的护理。无论分期或种族如何，接受符合指南的护理的非 MSH 或 MSH 治疗患者的 OS 更长。
MSH 患者接受符合指南的护理的可能性较低，无论 MSH 状态如何，少数民族患者接受符合指南的护理的可能性较低。符合指南的护理与改善 OS 相关。
