Racial disparities in treatment for pancreatic cancer and impact on survival: A population-based analysis

Purpose: Pancreatic adenocarcinoma is the fourth leading cause of cancer-related deaths in both men and women. Mortality from pancreatic cancer is higher amongst blacks compared to other races. We performed this analysis with the aim of examining racial disparity for receipt pancreatic cancer treatment and its association with survival. Methods: Using the surveillance, epidemiology, and end results (SEER) database from 1988 to 2008, cases with locoregional pancreatic cancer were analysed. Kaplan- Meier survival curves were assessed to assess the survival amongst various races. Cox proportional hazard model was built to assess the impact of receipt of treatment on the racial disparity in survival. Results: Of 16,282 cases with locoregional pancreatic cancer, 1,806 (11%) occurred in blacks. Median survival was 8-9 months with poorest survival in blacks. Blacks and Hispanics received radiation treatment less often compared to other races. On Cox regression logistic regression analysis, blacks had 20% poorer survival compared to whites. Treatment for pancreatic cancer explained only one-fourth of this poorer survival. Conclusion: Blacks have worst survival from locoregional pancreatic cancer. Receiving treatment for pancreatic cancer only explains 25% of the poorer survival amongst blacks, suggesting role of other factors. Studies are suggested to (a) identify barriers in receipt of treatment for pancreatic cancer amongst blacks and (b) to assess role of genetic and other factors to examine racial differences in survival.