Are Race or Sex Associated With Mortality, Interventions, or Palliative Care Use in Pancreatic Cancer Patients? An Urban Center Experience, 2010-2017: 105

INTRODUCTION: Treatment options for pancreatic cancer are well-established, but patients do not necessarily receive the same treatments for various reasons including unequal access to care, differences in medical literacy, or cultural barriers. We investigated whether or not disparities existed in the management of pancreatic cancer based on sex and race at our university-affiliated, urban hospital from 1/1/2010 through 12/31/2018. METHODS: We did a retrospective review of all pancreatic cancer cases diagnosed from 2010–2017 at our institution. We used Fisher's exact test to evaluate overall mortality and palliative care team involvement by patient sex and race. We used Cox proportional univariate regressions to compare survival following surgery, chemotherapy, and palliative care involvement based on sex, race, and age group (≤80 years old and >80 years old). Kaplan-Meier plots were used to determine mortality by sex, race, and age group. RESULTS: We identified 201 patients with biopsy-proven pancreatic cancer. Of those, 110 (54.7%) had died by date of last contact. We found no statistically significant difference in overall mortality based on sex, race, or age group. Chemotherapy did not confer a survival advantage, but we found an overall decrease in mortality following surgical intervention (HR 0.39, 95% CI 0.24–0.65; P = 0.0003) that was particularly evident in the first 1000 days following diagnosis (Figure 1). The palliative care team was involved in just 61/201 (30.3%) of cases with white patients being 70% less likely to have documented contact with the service compared to non-white patients ( P = 0.004). Black patients had a higher likelihood than white patients of being seen by the palliative care team while hospitalized (OR 3.36, 95% CI 1.70–6.96; P = 0.0007). CONCLUSION: Sex and age group were not associated with differences in treatment. While surgical intervention appeared to be beneficial for the first three years following diagnosis, overall mortality after 1000 days was unchanged. Palliative care service has been underutilized across the cohort, despite there not being a long-term survival benefit with chemotherapy or surgery. White patients were less likely than black patients to be seen by our palliative care team, which could reflect a tendency to pursue more aggressive treatments or possibly decreased receptivity to palliative care involvement in this patient population. This discrepancy must be examined further through prospective or cross-sectional studies for clarification.