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Disparities in Pancreas Cancer Care

Abraham, Anasooya ; Al-Refaie, Waddah B. ; Parsons, Helen M. ; Dudeja, Vikas ; Vickers, Selwyn M. ; Habermann, Elizabeth B.

Annals of surgical oncology, 2013-06, Vol.20 (6), p.2078-2087 [Periódico revisado por pares]

New York: Springer-Verlag

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Título:
Disparities in Pancreas Cancer Care
Autor: Abraham, Anasooya ; Al-Refaie, Waddah B. ; Parsons, Helen M. ; Dudeja, Vikas ; Vickers, Selwyn M. ; Habermann, Elizabeth B.
Assuntos: Adolescent ; Adult ; African Americans - statistics & numerical data ; Aged ; Aged, 80 and over ; California ; Chemotherapy, Adjuvant - statistics & numerical data ; Chi-Square Distribution ; European Continental Ancestry Group - statistics & numerical data ; Female ; Healthcare Disparities - ethnology ; Healthcare Disparities - statistics & numerical data ; Humans ; Logistic Models ; Male ; Medicaid - statistics & numerical data ; Medically Uninsured - statistics & numerical data ; Medicare - statistics & numerical data ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate Analysis ; Oncology ; Pancreatectomy - statistics & numerical data ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - therapy ; Pancreatic Tumors ; Radiotherapy, Adjuvant - statistics & numerical data ; Registries ; Sex Factors ; Surgery ; Surgical Oncology ; United States ; Young Adult
É parte de: Annals of surgical oncology, 2013-06, Vol.20 (6), p.2078-2087
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: Background Prior literature shows demographic differences in patients surgically treated for pancreatic cancer (PC). We hypothesized that socioeconomic disparities also exist across all aspects of PC care, in both surgically and non-surgically treated patients. Methods We identified a cohort of patients with American Joint Committee on Cancer (AJCC) stage I–IV PC in the 1994–2008 California Cancer Registry. We used multivariate logistic regression to examine the impact of race, sex, and insurance status on (1) resectability (absence of advanced disease), (2) receipt of surgery, and (3) receipt of adjuvant/primary chemotherapy (+/– radiotherapy). Results Among 20,312 patients, 7,585 (37 %) had resectable disease; 40 % who met this definition received surgery ( N = 3,153). On multivariate analysis, males were less likely to present with resectable tumors [odds ratio (OR) 0.91, 95 % confidence interval (CI) 0.85–0.96], but sex did not otherwise predict treatment. Black patients were as likely as White patients to show resectable disease, yet were less likely to receive surgery (OR 0.66, 95 % CI 0.54–0.80), and adjuvant (OR 0.75, 95 % CI 0.58–0.98) or primary chemotherapy +/– radiation. Compared with Medicaid recipients, non-Medicare/Medicaid enrollees were more likely to receive surgery (OR 1.7, 95 % CI 1.4–2.2), and the uninsured were less likely to receive adjuvant therapy (OR 0.54, 95 % CI 0.30–0.98). Conclusions Though Black patients appear to present with comparable rates of resectability, they receive care that deviates from current guidelines. Insurance status is associated with inferior profiles of resectability and treatments. Future policies and research should identify effective strategies to ensure receipt of standard care.
Editor: New York: Springer-Verlag
Idioma: Inglês

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Disparities in Pancreas Cancer Care

Abraham, Anasooya ; Al-Refaie, Waddah B. ; Parsons, Helen M. ; Dudeja, Vikas ; Vickers, Selwyn M. ; Habermann, Elizabeth B.

New York: Springer-Verlag

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