The roles of race and social determinants of health in pancreatic adenocarcinoma diagnosis and treatment.
Authors: Ajilore Priscilla Olabimpe , Fishbein Thomas M. , Winslow Emily R. , Jackson Patrick G. , Unger Keith Robert , Weiner Louis M. , Marshall John , He Aiwu Ruth , Weinberg Benjamin Adam , Mukherji Reetu , Wang Hongkun , Noel Marcus Smith 
Published: June 2023

e18565

Background: Pancreatic ductal adenocarcinoma (PDAC) is a significant health crisis in the United States and will soon become the second leading cause of death, despite being the 10th most common cancer. It is also associated with disparities in both incidence and outcomes among racial groups, socioeconomic status (SES), and insurance status.Given the dismal outcomes with advanced stage, early diagnosis is critical. The objective of this study is to evaluate the association of social determinants of health with timeframe to PDAC diagnosis (TPD) at an academic center. Methods: This study was an IRB approved retrospective analysis that utilized chart data from patients that were diagnosed with PDAC at the Georgetown University Lombardi Comprehensive Cancer Center from December 2018 to February 2022. Patient demographics were captured from patient charts. The main outcome of this study was TPD, defined as the number of days that elapsed between first symptom presentation to medical personnel and the date of histologic diagnosis. Secondary outcomes included the frequency of being offered specific cancer treatments. The Kruskal-Willis test was used to evaluate for a difference between median Time to Diagnosis among racial and insurance groups, and the Wilcoxon method used for post-hoc analysis. Results: A total of 200 patients (115 females [57%]; 85 males [43%]) were included in the analysis. There were 111 White (W, 55.5%), 71 African American (AA, 34%), 10 Asian (A, 5%), 3 Hispanic (H, 1.5%) and 5 Unknown (U, 2.5%) patients. AA patients received their diagnosis at a median of 16 [P < 0.0001], and 19 [P = 0.001] days later than W and A patients, respectively. Compared to AA, A patients were more likely to be offered clinical trials (odds ratio [OR], 5.27 [95% CI, 1.19-23.2]). Chemotherapy, surgery, and radiation therapy were offered to patients at similar rates, regardless of their racial group, sex, or insurance status. AA patients presented with unresectable PDAC at higher rates than their counterparts in other racial groups: 66.2% compared to 54% of W and 50% of A patients. There were no statistically significant correlations between health outcome rankings and TPD among patients from Virginia and Maryland. In DC communities with poor health outcome rankings were positively associated with longer TPD, with a Spearman’s correlation coefficient of 0.29 (P < 0.03). Conclusions: This study highlights disparities in TPD among racial groups. Racial groups were offered treatments at similar rates, but AA patients were less likely to be offered clinical trials. Furthermore, geographical locations with lower health outcome ratings experienced longer time to diagnosis. Our findings may inform institutional policymaking and quality measures regarding the allocation of resources to achieve better racial and geographic equities in treatment of patients with PDAC.