Regional, Racial Differences in Surgical Resections for Pancreatic Cancer

Jason S. Gold MD FACS Chief of Surgical Oncology, VA Boston Healthcare System Assistant Professor of Surgery, Harvard Medical School Brigham and Women’s Hospital

Dr.  Jason Gold

MedicalResearch.com Interview with:
Jason S. Gold MD FACS

Chief of Surgical Oncology, VA Boston Healthcare System
Assistant Professor of Surgery, Harvard Medical School
Brigham and Women’s Hospital

Medical Research: What is the background for this study?

Dr. Gold: Pancreas cancer is a lethal disease. While advances in the best available care for pancreas cancer are desperately needed, improvements can be made in addressing disparities in care. This study aimed to evaluate associations of social and demographic variables with the utilization of surgical resection as well as with survival after surgical resection for early-stage pancreas cancer.

Medical Research: What are the main findings?

Dr. Gold: The main findings are the following:

1:     We found that less than half of patients with early-stage pancreas cancer undergo resection in the United States. Interestingly, the rate of resection has not changed with time during the eight-year study period.

2.  We also found significant disparities associated with the utilization of surgical resection for early-stage pancreas cancer in the United States. African American patients, Hispanic patients, single patients, and uninsured patients were significantly less likely to have their tumors removed. There were regional variations in the utilization of surgical resection as well. Patients in the Southeast were significantly less likely to have a pancreas resection for cancer compared to patients in the Northeast.

3. Among the patients who underwent surgical resection for early-stage pancreas cancer, we did not see significant independent associations with survival for most of the social and demographic variables analyzed. Surprisingly, however, patients from the Southeast had worse long-term survival after pancreas cancer resection compared to those in other regions of the United States even after adjusting for other variables.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gold: From this study, it appears that in the United States, the outcome of patients with pancreas cancer can be improved by increasing the utilization of surgical resection where appropriate. In particular, disparities in the utilization of pancreas cancer resection, particularly among African American patients, Hispanic patients, single patients, uninsured patients, and patients located in the Southeast, need to be addressed.

It is reassuring that among patients who underwent surgical resection for early stage-pancreas cancer, social and demographic variables other than geographic location, such as race, ethnicity, marital status, and insurance status, were not independently associated with survival for patients who underwent resection of early-stage pancreas cancer.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gold: Further research is needed to determine why patients in the Southeast have worse survival after resection for early-stage pancreas cancer. Perhaps there are regional variations in the quality of care for pancreas cancer. Pancreatic surgery is a complex procedure, and optimal outcomes are often achieved at experienced centers. Furthermore, it is thought that pancreas cancer care is best coordinated in a comprehensive multidisciplinary setting. It is conceivable that access to experienced pancreas surgical centers and centers with multidisciplinary excellence in pancreas cancer treatment vary across the country.

From this study, it appears that in the United States, the outcome of patients with pancreas cancer can be improved by increasing the utilization of surgical resection where appropriate. Further efforts need to be made to assure that all patients, particularly African American patients, Hispanic patients, single patients, uninsured patients, and patients located in the Southeast, have access to pancreas cancer resection.

Citation:

Shapiro M, Chen Q, Huang Q, et al. Associations of Socioeconomic Variables With Resection, Stage, and Survival in Patients With Early-Stage Pancreatic Cancer.JAMA Surg. Published online November 18, 2015. doi:10.1001/jamasurg.2015.4239.

Jason S. Gold MD FACS (2015). Regional, Racial Differences in Surgical Resections for Pancreatic Cancer 

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.