|
|
Back to 2017 Posters
TARGETABLE DISPARITIES IN THE SURGICAL TREATMENT OF EARLY-STAGE PANCREATIC CANCER IN KENTUCKY
Heather A. Frohman*1, Quan Chen5, Bin Huang4, Anh-Thu Le1, Sean Dineen1, Jeremiah T. Martin2, Ching-Wei Tzeng3
1Department of Surgery, University of Kentucky, Lexington, KY; 2Department of Cardiothoracic Surgery, Southern Ohio Medical Center, Portsmouth, OH; 3Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX; 4Department of Biostatistics, University of Kentucky, College of Public Health, Lexington, KY; 5Biostatistics and Bioinformatics Shared Resource Facility, University of Kentucky, Markey Cancer Center, Lexington, KY
Introduction:
There has been a national failure to operate on more than 50% of patients with resectable pancreatic adenocarcinoma (PDAC). The primary aims of this study were to evaluate surgery rates and identify targetable disparities in resectable PDAC patients in the state of Kentucky.
Patients and Methods:
Patients with clinical stage I-II PDAC in the Kentucky Cancer Registry (2004-2013) were included. Multivariate modeling was used to identify factors associated with surgery received and overall survival (OS). An academic hospital (AH) was defined as one of the four main campus hospitals staffed by faculty from either of the two allopathic medical schools in Kentucky.
Results:
Of 1,680 in-state patients diagnosed with stage I-II PDAC over the study period, only 849 (50.5%) underwent curative-intent resection. Resection rates did not change over the decade studied (range 44.5-55.7%, p=0.58). Only 45.6% of patients had treatment at an AH. There were no time trends in referral rates to AH. AH were more likely to treat patients with the following traits: Black, Appalachian county, active smoker, uninsured or Medicaid, counties with lower education levels and greater poverty (all p<0.039). Total resections were almost evenly split between AH and non-AH with 53.4% occurring at an AH. However, the resection rate was significantly higher at AH vs. non-AH (59.1% vs. 43.3%, p<0.001).
Variables independently associated with resection were AH (OR 1.64, p<0.001), age (20-49, 50-64, 65-74, vs. 75+ years, OR 5.54, 3.15, 2.54, p<0.001 for each), stage II vs. I (OR 2.11, p<0.001), and residing in less impoverished counties (low vs. very high poverty, OR 1.66, p=0.01). Gender, insurance type, county education level, and Appalachian county were not significantly associated with resection rate. Pre-treatment clinical factors independently associated with improved OS included resection (hazard ratio, HR 0.35, p<0.001), younger age (age 65-74 vs. age 75+, HR 0.77, p<0.001), and early stage (stage I vs. II, HR 0.71, p<0.001).
Conclusions:
The most significant disparity influencing resection rates in early stage PDAC in Kentucky is facility type, with AH being 64% more likely to resect patients, even when accounting for differences in patient demographics. Surgical resection remains the most important determinant of OS in stage I-II PDAC. In Kentucky, coordinated statewide efforts to improve regionalization of care to academic hospitals may improve both resection rates and OS for patients with early-stage PDAC.
Back to 2017 Posters
|
