Abstract B109: Hispanics have improved overall survival with pancreatic ductal adenocarcinoma regardless of treatment facility
Authors: Riner Andrea N , Underwood Patrick , Yang Kai , Chamala Srikar , Qiu Peihua , Trevino Jose G 
Published: September 2020

Abstract
Introduction: Disparities exist in patients with pancreatic ductal adenocarcinoma (PDAC). Historically, minority populations including mostly black race is regarded as a negative predictor of receiving expected treatment for clinical stage and overall survival. While better clinical outcomes are suggested at Academic Programs for minority populations, the differentiation amongst Hispanic populations or treatment facility types is unknown. We hypothesized that outcomes among racial/ethnic PDAC patients are influenced by facility type where care is received. Methods: Patients diagnosed with PDAC (2004 to 2015) were identified through the National Cancer Data Base (NCDB). 170,466 patients were included in the analysis. Cox proportional hazard model was used to compare survival between race/ethnic groups (Non-Hispanic Whites, Non-Hispanic Blacks, Hispanics) across facility types, while adjusting for sex, age, median income, insurance, urban vs rural, Charlson-Deyo score, stage, and surgical resection. Median survival times and estimated survival curves were based on the fitted Cox model. The facility types were identified as Community Cancer Program (CCP), Comprehensive Community Cancer Program (CCCP), Academic Research Program (ARP) and Integrated Network Cancer Program (INCP). Results: Compared to Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB) have worse overall survival (HR = 1.05, p &lt; 0.001) and Hispanics have better overall survival (HR = 0.92, p &lt; 0.001) among all facility types. After controlling for socioeconomic and clinical covariates, NHB have better overall survival compared to NHW (HR = 0.95, p &lt; 0.001), while again Hispanics have the best comparative outcomes (HR = 0.83, p &lt; 0.001). Although this effect is significant among all facility types for Hispanics, the improved survival is most pronounced at ARPs (HR 0.78, p &lt; 0.001) and INCPs (HR 0.77, p &lt; 0.001). The improved survival of NHB over NHW is seen at CCCP (HR 0.97, p = 0.025) and ARP (HR 0.96, p = 0.003), and this is influenced mostly by wealth and surgical resection. Additionally, each race/ethnic group has a median survival benefit at ARPs (NHW = 9.26 months, NHB = 7.69 months, Hispanics = 9.07 months), whereas median survival was most reduced at CCPs (NHW = 4.93 months, NHB = 4.57 months, Hispanics = 6.14 months). Median survival in Hispanics was also improved at INCPs (8.38 months). Conclusion: Overall and median survival are improved at ARP for all races/ethnicities. Hispanics have better overall survival comparatively, at all programs. However, the survival benefit of Hispanics is greater at ARPs and INCPs. Non-Hispanic Blacks have worse overall survival, but when survival is adjusted for higher income and surgical resection, NHB have better overall survival than NHW at higher volume centers. Further research is needed to determine why survival among Hispanics differs disproportionately across facility types (tumor biology) and to understand the impact of income and surgery on significantly improved survival in NHB.
Citation Format: Andrea N Riner, Patrick Underwood, Kai Yang, Srikar Chamala, Peihua Qiu, Jose G Trevino. Hispanics have improved overall survival with pancreatic ductal adenocarcinoma regardless of treatment facility [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B109.