Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma?

Michael C. Cheung, Relin Yang, Margaret M Byrne, Carmen C. Solorzano, Attila Nakeeb, Leonidas G. Koniaris

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND: The objective of this study was to define the effects of socioeconomic status (SES) and other demographic variables on outcomes for patients with pancreatic adenocarcinoma. METHODS: Florida cancer registry and inpatient hospital data were queried for pancreatic adenocarcinoma diagnosed from 1998 to 2002. RESULTS: In total, 16,104 patients were identified. Low SES (LSES) patients were younger at diagnosis (P < .001) but presented with similar disease stage and tumor grade. LSES patients were less likely to receive surgical extirpation (16.5% vs 19.8%; P < .001), chemotherapy (30.7% vs 36.4%; P < .001), or radiotherapy (14.3% vs 16.9%; P=.003). Among surgical patients, 30-day mortality was significantly higher (5.1% vs 3.7%; P < .001) and overall median survival was significantly worse (5.0 months vs 6.2 months; P < .001) in the LSES cohorts. Although surgical patients who were treated at teaching facilities (TF) did significantly better; an increased 30-day surgical mortality (2.2% vs 1.3%; P < .001) and decreased median survival (5 months for poverty level >15% vs 6.2 months for poverty level <5%; P < .001) also were observed for patients of LSES. In a multivariate analysis that corrected for patient comorbidities, significant independent predictors of a poorer prognosis included LSES (hazard ratio [HR], 1.09); treatment at a non-TF (HR, 1.09); and failure to receive surgical extirpation (HR, 1.92), chemotherapy (HR 1.41), or radiation (HR 1.25). CONCLUSIONS: Patients of LSES were less likely to receive surgical extirpation, chemotherapy, or radiation and had significantly higher perioperative and long-term mortality rates. A greater understanding of the barriers to providing optimal care and identifying means for improving successful delivery of therapies to the poor with pancreatic cancer are needed.

Original languageEnglish
Pages (from-to)723-733
Number of pages11
JournalCancer
Volume116
Issue number3
DOIs
StatePublished - Feb 1 2010

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Social Class
Adenocarcinoma
Radiation
Drug Therapy
Poverty
Pancreatic Neoplasms
Registries
Comorbidity
Inpatients
Multivariate Analysis
Demography
Mortality
Therapeutics
Neoplasms

Keywords

  • Outcomes
  • Pancreatic cancer
  • Racial disparities
  • Socioeconomic status

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Cheung, M. C., Yang, R., Byrne, M. M., Solorzano, C. C., Nakeeb, A., & Koniaris, L. G. (2010). Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma? Cancer, 116(3), 723-733. https://doi.org/10.1002/cncr.24758

Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma? / Cheung, Michael C.; Yang, Relin; Byrne, Margaret M; Solorzano, Carmen C.; Nakeeb, Attila; Koniaris, Leonidas G.

In: Cancer, Vol. 116, No. 3, 01.02.2010, p. 723-733.

Research output: Contribution to journalArticle

Cheung, MC, Yang, R, Byrne, MM, Solorzano, CC, Nakeeb, A & Koniaris, LG 2010, 'Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma?', Cancer, vol. 116, no. 3, pp. 723-733. https://doi.org/10.1002/cncr.24758
Cheung MC, Yang R, Byrne MM, Solorzano CC, Nakeeb A, Koniaris LG. Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma? Cancer. 2010 Feb 1;116(3):723-733. https://doi.org/10.1002/cncr.24758
Cheung, Michael C. ; Yang, Relin ; Byrne, Margaret M ; Solorzano, Carmen C. ; Nakeeb, Attila ; Koniaris, Leonidas G. / Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma?. In: Cancer. 2010 ; Vol. 116, No. 3. pp. 723-733.
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abstract = "BACKGROUND: The objective of this study was to define the effects of socioeconomic status (SES) and other demographic variables on outcomes for patients with pancreatic adenocarcinoma. METHODS: Florida cancer registry and inpatient hospital data were queried for pancreatic adenocarcinoma diagnosed from 1998 to 2002. RESULTS: In total, 16,104 patients were identified. Low SES (LSES) patients were younger at diagnosis (P < .001) but presented with similar disease stage and tumor grade. LSES patients were less likely to receive surgical extirpation (16.5{\%} vs 19.8{\%}; P < .001), chemotherapy (30.7{\%} vs 36.4{\%}; P < .001), or radiotherapy (14.3{\%} vs 16.9{\%}; P=.003). Among surgical patients, 30-day mortality was significantly higher (5.1{\%} vs 3.7{\%}; P < .001) and overall median survival was significantly worse (5.0 months vs 6.2 months; P < .001) in the LSES cohorts. Although surgical patients who were treated at teaching facilities (TF) did significantly better; an increased 30-day surgical mortality (2.2{\%} vs 1.3{\%}; P < .001) and decreased median survival (5 months for poverty level >15{\%} vs 6.2 months for poverty level <5{\%}; P < .001) also were observed for patients of LSES. In a multivariate analysis that corrected for patient comorbidities, significant independent predictors of a poorer prognosis included LSES (hazard ratio [HR], 1.09); treatment at a non-TF (HR, 1.09); and failure to receive surgical extirpation (HR, 1.92), chemotherapy (HR 1.41), or radiation (HR 1.25). CONCLUSIONS: Patients of LSES were less likely to receive surgical extirpation, chemotherapy, or radiation and had significantly higher perioperative and long-term mortality rates. A greater understanding of the barriers to providing optimal care and identifying means for improving successful delivery of therapies to the poor with pancreatic cancer are needed.",
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N2 - BACKGROUND: The objective of this study was to define the effects of socioeconomic status (SES) and other demographic variables on outcomes for patients with pancreatic adenocarcinoma. METHODS: Florida cancer registry and inpatient hospital data were queried for pancreatic adenocarcinoma diagnosed from 1998 to 2002. RESULTS: In total, 16,104 patients were identified. Low SES (LSES) patients were younger at diagnosis (P < .001) but presented with similar disease stage and tumor grade. LSES patients were less likely to receive surgical extirpation (16.5% vs 19.8%; P < .001), chemotherapy (30.7% vs 36.4%; P < .001), or radiotherapy (14.3% vs 16.9%; P=.003). Among surgical patients, 30-day mortality was significantly higher (5.1% vs 3.7%; P < .001) and overall median survival was significantly worse (5.0 months vs 6.2 months; P < .001) in the LSES cohorts. Although surgical patients who were treated at teaching facilities (TF) did significantly better; an increased 30-day surgical mortality (2.2% vs 1.3%; P < .001) and decreased median survival (5 months for poverty level >15% vs 6.2 months for poverty level <5%; P < .001) also were observed for patients of LSES. In a multivariate analysis that corrected for patient comorbidities, significant independent predictors of a poorer prognosis included LSES (hazard ratio [HR], 1.09); treatment at a non-TF (HR, 1.09); and failure to receive surgical extirpation (HR, 1.92), chemotherapy (HR 1.41), or radiation (HR 1.25). CONCLUSIONS: Patients of LSES were less likely to receive surgical extirpation, chemotherapy, or radiation and had significantly higher perioperative and long-term mortality rates. A greater understanding of the barriers to providing optimal care and identifying means for improving successful delivery of therapies to the poor with pancreatic cancer are needed.

AB - BACKGROUND: The objective of this study was to define the effects of socioeconomic status (SES) and other demographic variables on outcomes for patients with pancreatic adenocarcinoma. METHODS: Florida cancer registry and inpatient hospital data were queried for pancreatic adenocarcinoma diagnosed from 1998 to 2002. RESULTS: In total, 16,104 patients were identified. Low SES (LSES) patients were younger at diagnosis (P < .001) but presented with similar disease stage and tumor grade. LSES patients were less likely to receive surgical extirpation (16.5% vs 19.8%; P < .001), chemotherapy (30.7% vs 36.4%; P < .001), or radiotherapy (14.3% vs 16.9%; P=.003). Among surgical patients, 30-day mortality was significantly higher (5.1% vs 3.7%; P < .001) and overall median survival was significantly worse (5.0 months vs 6.2 months; P < .001) in the LSES cohorts. Although surgical patients who were treated at teaching facilities (TF) did significantly better; an increased 30-day surgical mortality (2.2% vs 1.3%; P < .001) and decreased median survival (5 months for poverty level >15% vs 6.2 months for poverty level <5%; P < .001) also were observed for patients of LSES. In a multivariate analysis that corrected for patient comorbidities, significant independent predictors of a poorer prognosis included LSES (hazard ratio [HR], 1.09); treatment at a non-TF (HR, 1.09); and failure to receive surgical extirpation (HR, 1.92), chemotherapy (HR 1.41), or radiation (HR 1.25). CONCLUSIONS: Patients of LSES were less likely to receive surgical extirpation, chemotherapy, or radiation and had significantly higher perioperative and long-term mortality rates. A greater understanding of the barriers to providing optimal care and identifying means for improving successful delivery of therapies to the poor with pancreatic cancer are needed.

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