Racial/Ethnic Differences and Effects of Clinical/Socioeconomic Factors on Time from Diagnosis to Treatment in Pancreatic Cancer.

Abstract

Purpose: Five-year survival for pancreatic adenocarcinoma (PDAC) is < 10% but can vary by a patient's race, socioeconomic status (SES), and the factors related to the neighborhood where a patient lives (nSES) . Prolonged time from diagnosis to first treatment (T2T) is another important disparity indicator. Here, we examined the effect of race, nSES, and patient-level clinical factors on T2T and survival in metastatic PDAC (mPDAC) patients.

Methods: Patients with mPDAC treated at an academic cancer center between 2010 and 2018 (n = 334) were evaluated for nSES measures related to racial concentration, neighborhood deprivation, stability, immigration status, and transportation access from the US Census. We assessed and reported the effects of nSES and patient-level variables (age, race, gender, Charlson Comorbidity Index (CCI), etc.) on T2T and survival using univariate and multivariate Cox proportional hazards regression, hazard ratios (HR), confidence intervals (CI).

Results: 82.9% of the patients were White; 17.1% were Black. Median T2T was 26 days with no significant difference in T2T and survival by race. In multivariable models, no nSES variables were significantly associated with T2T. T2T did not significantly impact survival; however, receipt of chemotherapy (HR = 0.14 [95% CI = 0.06, 0.30]) was associated with better survival outcomes.

Conclusion: Among patients with mPDAC, T2T was not associated with race/ethnic disparities or survival in a mostly White, high SES population treated at a comprehensive cancer center. Future investigations into pancreatic cancer disparities may be warranted in other hospital settings and in larger, more diverse study samples.