SOCIOECONOMIC INEQUALITIES IN SURGICAL RESECTION FOR PANCREATIC CANCER – A META-ANALYSIS
Hamza Khan*1, Martin J. Heslin2, Fabian M. Johnston3, Annabelle L. Fonseca2
1Valley Health System, Las Vegas, NV; 2University of South Alabama, Mobile, AL; 3Johns Hopkins University, Baltimore, MD
Introduction
Curative-intent surgical resection is the only potentially curative therapy in pancreatic cancer. Disparities in access to surgery contribute to disparate and inequitable outcomes in patients. The purpose of this study was to systematically review socioeconomic factors responsible for disparities in receipt of curative-intent surgical resection in pancreatic cancer.
Methods
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used to conduct this systematic review. PubMed, Web of Science, Embase and Medline databases were examined from 2000 to 2021. A combination of key MeSH terms (disparity, equity, access, oncologic care, cancer, pancreas, age, race, gender, insurance, socioeconomic) were used for the search criteria. Studies specifically evaluating surgical resection for non-metastatic pancreatic adenocarcinoma cancer were included. Non-USA studies were excluded. Meta-analysis was performed using Review Manager (RevMan) 5.4, The Cochrane Collaboration, 2020.
Results
7202 studies were identified out of which n=4558 duplicates and n=2494 non-primary studies were excluded. 150 full-text reports were reviewed and n=129 studies excluded as they did not analyze surgery specific data. n=4 studies were non-USA based. 17 articles were included in the systematic review that evaluated patients from 1998-2017. A total of 14 studies were based on national databases whereas 3 were state-wide or single institutional studies. In total 82,714 out of 190,701 (43.4%) patients underwent surgery. Age-related disparities were evaluated in 14 studies out of which 13 (93%) reported older age being predictive for non-receipt of surgery. Gender was analyzed in 14 studies, of which 1 study reported males to be predictive of decreased surgery. Sixteen studies evaluated racial or ethnic disparities, of which 14 (88%) reported disparities in Black or other minority patients. Insurance status was evaluated by 7 studies, of which 6 (86%) reported non-private insurance status as an independent risk factor for decreased receipt of surgery. On meta-analysis, White patients (OR 1.30, 95% CI 1.26-1.35, p=0.005) as well as private insurance (OR 1.58, 95% CI 1.54-1.63, p<0.001) had a higher likelihood of receipt of surgical resection (Figure 1).
Conclusions
Race and Insurance status significantly influence the likelihood of receiving curative-intent surgery in patients with pancreatic cancer. Additional studies are required to elucidate specific barriers in access to surgical care, that may be targets for intervention.
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