Persisting disparities in pancreatic cancer care

Disparities in pancreatic cancer care are persistent and have an impact on the health outcomes of underserved patients. Physician/surgeon bias, underrepresentation of certain subgroups in clinical trials, and lack of access to high-volume hospitals may be factors that drive these disparities. In addition, precision medicine may exacerbate the observed health inequalities [1].

Prof. Susan Tsai (Medical College of Wisconsin, WI, USA) explained that health disparities in pancreatic cancer surgery are persistent. “Patients who are White, insured, and have a high socioeconomic status (SES) are more likely to receive pancreatic surgery than their counterparts. Moreover, patients who live in an urban environment are more likely to receive surgery than those who live in a rural setting.”

It has been demonstrated that the mortality rate following pancreatic surgery performed in high-volume hospitals (approximately 20 per year) is significantly lower than surgeries performed in low-volume hospitals [2]. The benefits of experienced surgeons and superior post-operative care in high-volume hospitals come at the expense of an increased travel distance and travel cost, which predominantly affects vulnerable minorities.

“The physician’s bias towards minority groups may add to these disparities,” said Prof. Tsai. A study by Lopez-Verdugo et al. demonstrated that non-Black minorities were less likely to receive neoadjuvant therapy than White patients and that a longer travel distance was associated with a reduced likelihood of being offered neoadjuvant therapy [3]. In addition, another study showed that patients from deprived areas were less likely to receive adjuvant therapies [4]. “Furthermore, Black and Hispanic patients are underrepresented in trials leading to cancer drug approval,” said Prof. Tsai. “In addition, disparities are perpetuated in the development of precision medicine. Since genomic data is mostly retrieved from European individuals, the artificial intelligence models based on these data are biased.

Centralisation and standardisation of high-risk surgery, optimising the delivery of locoregional care, leveraging emerging technologies, and developing community partnerships to engage underserved minorities are some of the measures we need to take to reduce the persisting disparities in pancreatic cancer care.”

1. Tsai S, et al. Access and Disparities in Pancreatic Cancer. Breakout Session: New Approaches and Equalizing Access in Pancreatic Cancer. ASCO GI 2022, 20–22 January.
2. Birkmeyer JD, et al. N Engl J Med. 2002;346:1128–1137.
3. Lopez-Verdugo F, et al. Ann Surg. 2021;Dec 23.
4. Mora J, et al. Am J Surg. 2021;222(1):10–17.

 

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Posted on 21 March 202217 May 2024