Abstract A94: Treatment disparities in pancreatic cancer: “Does our survival depend on where we go for care?”
Authors: Alamo Ines G. , Hodges Marcia A. , Behrns Kevin E. , Hughes Steve J. , George Thomas J. , Trevino Jose G. 
Published: October 2015

Introduction: Pancreatic cancer is the 4th leading cancer in the US with dismal survival rates with an overall five-year survival rate of 4%. Surgery remains the only potentially curative treatment of localized/early pancreatic cancer (PC). Additionally, treatment at tertiary care centers provides a significant survival advantage for patients resected with pancreatic cancer. In the State of Florida, blacks (African-Americans) have a greater incidence of PC rates than whites (Caucasians). Observations demonstrate that blacks are much less likely to undergo appropriate medical care in a tertiary care center such as University of Florida Health Cancer Center (UFHCC). Therefore, we evaluated treatment disparities among black patients afflicted with PC in Northern Florida.

Methods: In northern and central Florida, UFHCC is the major tertiary cancer center. Data was collected from the Florida Cancer Database System and University of Florida Health medical records. With IRB approval, data was collected and reviewed from 2000 to 2011 from all patients diagnosed or treated with PC.

Results: Between 2000-2011, 995 patients underwent consultation at UFHCC for PC (89% white vs 9% black). More blacks than whites (65% vs. 56%) presented with advanced stage III or IV disease but only 5% presented with resectable disease (Stage I or II) compared to 20% whites. Additionally, 603 blacks were diagnosed with PC in northern Florida but only 93 of these patients (15%) sought care at UFHCC for management of their disease. Of these patients, 58 % were females, 42 % were males. Large majority of blacks did not ever receive consultation at our tertiary care center. Interestingly, for blacks that were transferred from a center not specializing in PC to UFHCC with persistent disease (71% vs. 47%) had a significant survival advantage.

Discussion/Conclusion: In Florida, compared to whites, blacks have a higher incidence of PC but presented fewer times to UFHCC and with more advanced disease. Blacks were more likely to receive their care in very low volume hospitals and have limited access to specialists. In northern Florida, there is a clear discontinuity of care for blacks between diagnosis and access to treatment in a tertiary care center. Treatment disparities such as a lack of access to tertiary care centers, a lower likelihood to be offered surgery at a resectable stage, and patient refusal of surgical intervention have shown to play a role in adequate continuity of care among blacks. Whether treatment disparities have a statistically significant affect on survival rate of pancreatic cancer among blacks has yet to be formally evaluated. We encourage the call for further investigations in minority populations in other regions of the United States. There is strong need for research to whether these factors play a role in clinical outcomes where the disparity is becoming more evident.

Citation Format: Ines G. Alamo, Marcia A. Hodges, Kevin E. Behrns, Steve J. Hughes, Thomas J. George, Jr., Jose G. Trevino. Treatment disparities in pancreatic cancer: “Does our survival depend on where we go for care?” [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A94.