Pancreatic Cancer: Survival Differs by Race
Abstracts
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Introduction: Outcomes for pancreatic cancer are generally poor and this cancer accounts for the 5th leading cause of cancer-related death in the United States. Since most published studies are single institutional experiences, many of which are specialized centers, the true population-based outcomes remain unknown. In addition, these studies often cover the spectrum of pancreatic tumors, which includes some tumors with more favorable histology. In order to better understand the treatment and outcomes for pancreatic cancer, we examined a population-based, nationwide cancer database and studied survival rates for pancreatic adenocarcinoma. We identify areas where care may be improved. Methods: All patients diagnosed with pancreatic adenocarcinoma in the Surveillance, Epidemiology and End Results (SEER) cancer-registry from 1992-1998 were studied (n=11,173). Demographic (age and race), staging, treatment (surgical) and outcomes (2-yr and 3-yr survival) data were obtained. Disparities in treatment and survival were identified. Results: Mean age was similar for both White Americans and African Americans, 69 years and 66 years, respectively. No disparities were noted for the stage of presentation. Localized disease accounted for 7-8% of patients in both racial groups. Differences were seen regarding use of surgical treatment and survival outcomes. For all patients who were diagnosed with localized disease, 27% of White Americans underwent definitive resection of the tumor, as compared to 19% of African Americans, p=0.04. Of note, White Americans who underwent a Whipple operation for localized disease had better survival than similarly treated African Americans (19% vs. 11% 2-yr survival, p<0.04, and 14% vs. 7% 3-yr survival, p<.04). No identifiable variable in the SEER registry accounted for the survival difference. Conclusions: This population-based analysis demonstrates that significant racial differences exist for surgical treatment and survival (adjusted for treatment and stage) of pancreatic cancer patients. Since the prevalence of early disease was the same for all groups, we suspect that access to care may not play a major role in the survival disparities. Rather, other non-cancer factors such as co-morbid prevalence and severity may account for the racial survival differences. In order to attempt to improve the quality of care and outcomes in pancreatic cancer, the identified variations need to be studied further. |
