J. Fallon2, L. Demyan1, O. Standring1, E. Gazzara1, S. Hartman1, S. Pasha1, D. King3, J. Herman4, M. J. Weiss1,5, D. DePeralta1, G. Deutsch1 1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department Of Surgery, Manhasset, NY, USA 2Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA 3Northwell Health Cancer Institute, Department Of Medical Oncology/ Hematology, New Hyde Park, NY, USA 4Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department Of Radiation Oncology, Manhasset, NY, USA 5Feinstein Institutes for Medical Research, Institute Of Cancer Research, Northwell Health, Manhasset, NY, USA
Introduction: The impact of diagnosis setting on the initiation of definitive cancer care and overall survival has not been established in pancreatic cancer. The aim of this study was to better characterize the demographics and disparities between the diagnosis of pancreatic cancer during emergency presentation (EP) and the outpatient setting (OP).
Methods: Retrospective review of our institutional cancer registry was performed and of patients diagnosed with pancreatic cancer during 2019-2022, those who received definitive treatment within our system were included. Chi Square tests were used for categorical variables and one-way ANOVA with a Bonferroni correction was used for continuous variables. A Cox-regression analysis was performed to determine overall survival. Statistical significance was set at p<0.05.
Results: Of 665 patients reviewed, 266 met inclusion criteria, 112 were diagnosed during EP and 154 in the OP. Minorities (Black, American Indian/Alaskan Native, Asian, Other) were 1.3x more likely to be diagnosed during an EP (45% vs 32%; p = 0.041) which, after subset analysis, was driven by the Black population. At diagnosis there were no significant differences in clinical stage (AJCC 8th edition) between the cohorts (p = 0.474). Additionally, there were no significant differences in symptom presentation between groups (jaundice p=0.091; weight loss p=0.593; abdominal pain p=0.646.) Minorities were, however, significantly less likely to have a primary care physician at presentation (p = 0.003). For EP diagnoses, mean time from presentation to biopsy was 3.2x longer for minorities than white patients (17 days vs 5 days; p = 0.011) which subsequently led to a significantly longer time from presentation to definitive treatment for minorities compared to white patients (55 days vs 35 days; p = 0.003). Although not statistically significant, within the OP cohort, minorities faced a longer mean time from presentation to biopsy (21 days vs 14 days; p = 0.152) and presentation to definitive treatment (62 days vs 52 days; p = 0.299) when compared to their white counterparts.
Conclusion: Our analysis demonstrates minorities are more likely to be diagnosed with pancreatic cancer during an EP. However, despite showing acceleration of care during an EP, the time from presentation to definitive treatment is disproportionately longer in minorities than white patients. Future efforts should focus on developing innovative solutions, such as fast-track inpatient biopsy, to attempt to decrease this potential racial bias in pancreatic cancer care.
