W. Lutfi1, M. S. Zenati1, A. H. Zureikat1, H. J. Zeh1, M. E. Hogg1 1University Of Pittsburg,Pittsburgh, PA, USA
Introduction:
National adherence to guidelines recommended for treatment of resectable pancreatic ductal adenocarcinoma (PDAC) is a concern. We recently sought to address failure to treat for all PDAC stages using institutional data and found that demographic factors including age and gender were associated with treatment adherence disparities. This study aims to evaluate national expected treatment (ET) adherence for all PDAC stages. We hypothesized that both patient and hospital demographics are associated with national ET disparities for PDAC.
Methods:
We evaluated PDAC patients from the National Cancer Data Base (NCDB) from 2004 to 2013 who underwent treatment for clinical stages I through IV. ET was defined as surgery with or without chemotherapy or radiation therapy for stage I and II, chemotherapy or radiation for stage III, and chemotherapy for stage IV. Unexpected treatment (UT) was defined as no surgery for stage I and II, surgery for stage III, and radiation or surgery for stage IV. Patients without any therapy are no treatment (NT).
Results:
171,351 patients were identified. 56,589 (33.0%) were stage I and II, 23,459 (13.7%) were stage III, and 91,0303 (53.3%) were stage IV. 48.4% of patients received ET, 14.7% received UT, and 36.9% received no treatment (stage I and II – ET=41.1%, UT=30.0%, NT=28.9%; stage III – ET=65.4%, UT=6.8%, NT=27.8%; stage IV – ET=48.5%, UT=7.3%, NT=44.2%). On multivariable logistic regression analysis, older age, non-white race, lower socioeconomic status (SES), being uninsured or having Medicare, higher comorbidity index, being treated at a non-academic center, and being treated at a low volume hospital were all independent negative predictors of receiving ET; gender was not a predictor of ET. Subgroup analysis revealed that high volume academic centers had higher ET adherence for stage I/II and stage IV patients (P<0.001), however there were similar demographic predictors of poor adherence to ET. In terms of survival for stage I and II patients, ET had the best overall survival followed by UT and then NT (P<0.001). For locally advanced stage III, UT had the best overall survival followed by ET and NT (P<0.001). Of the stage III patients that received UT (surgery), 53% received neoadjuvant therapy and 51% had vascular abutment based on NCDB coding. For metastatic stage IV patients, UT had the best overall survival followed by ET and NT (P<0.001). Of the stage IV patients that received UT, 22% underwent surgical resection.
Conclusions:
Treatment, especially surgery, improves survival for patients with PDAC. Several patient and hospital factors impacted the ET of pancreas cancer on a national level. These national treatment disparities for PDAC are cause for concern, even at high-volume academic centers where ET adherence is highest. Future studies are needed to identify the causes of treatment disparities for PDAC with intervention measures aimed to relieve treatment disparities.