C. Ripat1,3, N. Merchant1,2, B. Azab1,2, J. Hu2,3, O. Carrasquillo3, D. Yakoub1,2 1University Of Miami,Department Of Surgery,Miami, FL, USA 2University Of Miami,Sylvester Comprehensive Cancer Center,Miami, FL, USA 3University Of Miami,Department Of Public Health Sciences,Miami, FL, USA
Introduction: Pancreatic adenocarcinoma is a highly lethal disease with 53,070 patients per year in the U.S., of whom 79% die within 1 year. Early surgical resection or neoadjuvant treatment in borderline resectable patients followed by surgery remains the only possible cure. However, not all patients receive prompt management. Factors associated with increased time from diagnosis to surgical resection (TTS) have yet to be analyzed and correlated with survival time.
Methods: Pancreatic adenocarcinoma patients who underwent surgical resection were identified using the National Cancer Data Base (NCDB). Regression analysis was performed to identify factors associated with increased TTS with or without neoadjuvant therapy. Cox proportional hazard model was used to determine if time to surgery was associated with increased mortality.
Results: 6359 patients from the NCDB were included. 5340 (Group 1) underwent surgical resection upfront and 1019 (Group 2) underwent neoadjuvant therapy followed by surgical resection. There was no difference in sex distribution in either groups. Median age was 64 years (26-89) in both groups. 87% and 88% of patients were white and 88% and 93% were non-Hispanic in Groups 1 and 2, respectively. In both groups, 48% of the patients were covered by private insurance, 43% by Medicare/Medicaid, while 2% had no insurance. In Group 1, 63% were diagnosed and 48% received care at a comprehensive community cancer program. In contrast, in Group 2, 52% were diagnosed and 68% received care at an academic/ research program. 40% patients in both groups resided in a medium to high income neighborhood whereas 11% resided in a low income neighborhood. 85% resided in an urban/metro setting. In Group 1, specialized cancer centers were predictors of decreased TTS, but academic and research programs were not. Increased age was associated with increased TTS (OR 1.15, 95% CI 1.09-1.23, p<0.01). Sex, race, ethnicity, insurance status and neighborhood income were not associated with increased TTS. In Group 2, black race was associated with increased TTS as were certain Hispanic subgroups. Residence in a metropolitan area was associated with decreased TTS as was shorter distance from hospital (OR 0.98, 95% CI 0.96-0.99, p< 0.01). Patients with adenocarcinoma grade 2 and 3 were associated with decreased TTS. Interestingly, patients with higher income had increased TTS. In subgroup analysis, Hispanic patients with private insurance or Medicare, but not Medicaid, had shorter TTS. Overall, increased TTS was significantly associated with shorter survival.
Conclusion: TTS in pancreatic adenocarcinoma patients is affected by race in certain localities as well as insurance status and accessibility to specific healthcare systems. Increased TTS had a detrimental effect on survival in these patients. Healthcare planning has to accommodate some of these factors to avoid disparity of care delivery to different populations.