Black patients with pancreatic cancer receive less treatment and fewer surgical procedures for resectable tumors than white patients, according to findings from a large cohort analysis (JAMA Surg. 2019 Dec 4. Epub ahead of print).

“Pancreatic ductal adenocarcinoma (PDAC) has a higher incidence and worse outcomes among black patients than white patients, potentially owing to a combination of socioeconomic, biological, and treatment differences,” explained Danielle R. Heller, MD, Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, and colleagues, who sought to find out whether treatment inequity contributes to this disparity in survival.

Dr Heller et al analyzed data of 278,936 patients from January 1, 2004, to December 31, 2015, for a primary end point of overall survival (OS).

Multivariable analyses were completed with the main interest being race-stratified therapy received, and the median follow-up was 24 months.

The factor most strongly associated with OS was resection (hazard ratio, 0.39; 95% CI, 0.38-0.39).With regard to treatment of partially resectable stage II disease, black patients had fewer surgical procedures than white patients; black patients also received slightly less chemotherapy than white patients for advanced disease.

“Black patients with PDAC present at younger ages and with more advanced disease than white patients, suggesting that differences in tumor biology may exist,” Dr Heller and colleagues posited.

In modelling that controlled for sociodemographic parameters, decreased survival for black patients persisted. However, when accounting for clinical parameters (ie, disease state and therapy) models showed no decrease in survival among black patients.

“Stage-specific gaps and differences in the provision of treatment were identified, suggesting potential factors underlying the disparity in survival; however, when controlled for treatment modality and disease stage, survival was comparable,” the investigators said.

“Inconsistencies in the care of black patients with pancreatic adenocarcinoma are associated with outcome differences observed when compared with their white counterparts,” they concluded.—Kaitlyn Manasterski