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DISPARITIES IN TIME TO FIRST TREATMENT FOR EARLY-STAGE PANCREATIC ADENOCARCINOMA IN PATIENTS RECEIVING UPFRONT SURGERY VS NEOADJUVANT THERAPY: A NATIONAL CANCER DATABASE ANALYSIS
Madeline M. Silva
*, Candice Vieira, Chen-Pin Wang, Xuemei Song, Mio Kitano, Colin M. Court, Caitlin A. McIntyre, Alexander A. Parikh
The University of Texas Health Science Center at San Antonio, San Antonio, TX
Introduction: Pancreatic cancer is the 2nd most common GI cancer in the US. It is often associated with poor prognosis due to late presentation with advanced stage or metastatic disease. Early-stage pancreatic adenocarcinoma diagnoses do occur, resulting in a significant improvement in patient outcomes. Typical treatment involves a multimodal approach, including surgical resection, systemic therapy, and radiation therapy. However, evidence remains controversial regarding the superiority of treatment approach and timing, as specific patient factors, such as insurance status, access to high-volume academic centers, and socioeconomic status cause frequent delays in care. Time to first treatment (TTT), regardless of treatment modality, remains understudied. This study aims to identify disparities in time to first treatment for early-stage pancreatic adenocarcinoma in patients receiving surgery vs neoadjuvant therapy, utilizing the National Cancer Database (NCDB).
Methods: Using data from the NCDB (2010-2021), patients with stage 1 or 2 pancreatic adenocarcinoma with known treatment history were identified. Patients were split into first treatment categories: neoadjuvant therapy (including chemotherapy, radiation therapy, or immunotherapy) or upfront surgical intervention. TTT, in days, was determined for each patient. Multivariable regression was utilized to assess variation in socioeconomic, insurance, and demographic factors associated with delays in TTT for both groups.
Results: A total of 50,721 patients with stage 1 or 2 pancreatic cancer had clinical data available, with 38,178 (75.3%) receiving first-line NAT and 12,543 (24.7%) receiving upfront surgery. The insurance status of these patients varied: 945 (1.9%) were uninsured, private insurance 15,310 (30.2%), Medicaid 2,866 (5.65%), Medicare (60.7%), and other government insurance (1.64%). All insurance groups were found to have a shorter median TTT in the upfront surgery group, compared to the NAT group (fig. 1). However, the most appreciable difference in median TTT occurred in the uninsured and Medicaid population, with more notably shorter median TTT to first-line surgical therapy (20, 25 days), compared to the same populations median TTT for first-line NAT (33, 34 days).
Conclusion:
This study demonstrates an association between faster median treatment times and upfront surgical therapy, particularly in uninsured and Medicaid populations. This suggests that delays in insurance acquirement and approval times significantly impact NAT start dates, thereby delaying treatment and possibly worsening patient mortality and outcomes. This study has implications for changes to patient treatment recommendations, with patient insurance status being considered when determining the optimal sequence of therapy, due to its influence on the timely receipt of guideline-concordant care.
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