Study Reveals Disparities in Pancreatic Cancer Care Impact Treatment and Survival
New research highlights how social vulnerability affects the quality of care for metastatic pancreatic cancer patients,impacting outcomes.
Published
A recent study published in the Journal of the National Thorough Cancer Network reveals meaningful disparities in the quality of care received by patients with metastatic pancreatic ductal adenocarcinoma (PDAC) based on their racial or ethnic minority status and social vulnerability. The findings underscore the urgent need for targeted interventions to ensure equitable access to optimal treatment and improved survival outcomes for all patients, nonetheless of their background.
The study’s findings indicate that patients classified as racial or ethnic minorities or as socially vulnerable frequently enough experience lower quality of care,leading to suboptimal treatment strategies and,ultimately,poorer survival rates.
“The results of our study highlight the need for targeted interventions to mitigate disparities in cancer care.”
Diamantis Tsilimigras, MD, PhD, The ohio State University Wexner Medical Center and James comprehensive Cancer Center
This alarming trend emphasizes the critical role of social determinants of health in cancer care and outcomes, issues deeply relevant to the healthcare landscape across the United States.
The Impact of Social Vulnerability
The research emphasizes the significant impact of the Social vulnerability Index (SVI) on the quality of cancer care. The SVI, a composite measure, considers various factors, including socioeconomic status, household characteristics, racial and ethnic minority status, and housing and transportation type. A higher SVI indicates greater vulnerability.
The data showed notable differences between patients who received a quality score of 1 or greater and those who scored 0:
- Patients with higher quality scores were more likely to be White (79.4% vs. 70.2%).
- They were also more likely to have a low SVI (32.1% vs. 22.5%).
- A greater percentage resided in areas with the highest median household income (top quartile: 24.1% vs. 19.2%).
These statistics paint a clear picture of how socioeconomic factors influence access to and the quality of cancer care, reflecting broader systemic issues within the U.S.healthcare system. for example, a patient living in a rural area with limited access to transportation might struggle to attend frequent chemotherapy appointments, directly impacting treatment adherence and outcomes.
Multivariate Analysis: A Stark Reality
Multivariate analysis further revealed the detrimental impact of a higher SVI on critical aspects of cancer care:
- A higher SVI was independently associated with a 28% lower odds of receiving palliative or hospice services (OR, 0.72; 95% CI,0.61-0.85).
- It also correlated with a 12% lower odds of receiving systemic therapy (OR, 0.88; 95% CI, 0.77-0.99).
- Patients with a higher SVI had a 30% lower chance of achieving a quality score of at least 1 (OR, 0.70; 95% CI, 0.54-0.91).
These findings highlight the systemic barriers that vulnerable populations face in accessing necesary medical care. Imagine a scenario where a low-income patient, lacking adequate health insurance and facing transportation challenges, is less likely to receive timely palliative care to manage pain and improve quality of life. This disparity underscores the urgent need for policies and interventions to address these inequities.
Study Methodology and Patient Demographics
The study leveraged data from the Surveillance, Epidemiology, and End Results (SEER) database, which captures data from approximately 95% of patients 65 years and older. This data was then linked to Medicare claims files. The study included patients diagnosed with stage IV PDAC between 2005 and 2019 who had Medicare Parts A and B coverage for at least one year prior to enrollment.
The study population consisted of 14,147 Medicare beneficiaries with metastatic PDAC, with a median age of 68 years. The majority of patients were White (78.8%) and female (52.9%), with a Charlson comorbidity index (CCI) score of 6 (86.5%). Of this group, 13.7% had a cancer-specific survival (CSS) of at least 12 months, 62.2% received systemic therapy, and 83.3% received palliative care and/or hospice services. Importantly, 93.3% of patients achieved a quality score of 1 or greater.
Defining Quality of Care
The study defined a metastatic PDAC quality score as meeting at least one of the following criteria:
- Receipt of systemic therapy in alignment with established guidelines.
- Receipt of palliative care or hospice services.
- Cancer-specific survival (CSS) for more than 12 months.
This composite measure provides a comprehensive assessment of the quality of care received by patients with metastatic pancreatic cancer. it takes into account both active treatment and supportive care, and also survival outcomes.
In patients who achieved a quality score of at least 1 compared with those who had a score of 0, the median age was younger at 68 years vs 72 years, and those achieving a quality score of at least 1 were more likely to be female at 53.3% vs 46.7% who were male patients.
Additional findings revealed that patients with a quality score of at least 1 were younger (median age 68 vs. 72 years), more likely to be female (53.3% vs. 46.7%), more likely to be married (56.1% vs. 40.3%),and more likely to have a lower CCI score.
Expert Perspectives and Policy Implications
Senior author Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, a surgical oncology specialist at The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, emphasized the importance of equitable care:
“Ensuring that all patients, regardless of their background, receive guideline-concordant care is critically important to improve outcomes for patients with metastatic pancreatic cancer. We found that while adherence to NCCN guidelines improved over time, there remain significant disparities in the receipt of guideline-concordant care among patients with metastatic pancreatic cancer which can, in turn, affect outcomes.”
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center
Dr. Tsilimigras suggests that “Federal policies that expand Medicaid or possibly expand Medicare coverage for palliative care can help reduce disparities. Moreover, policies that address social determinants of health—including financial aid for the most vulnerable populations and also understanding and addressing potential implicit biases relative to treatment recommendations—could help address disparities in equal access to care.”
These recommendations resonate with ongoing policy debates in the U.S. regarding healthcare access and affordability. As an example, expanding Medicaid eligibility could provide coverage to more low-income individuals, while addressing implicit biases in treatment recommendations necessitates cultural competency training for healthcare providers.
Moving Forward: Addressing the Challenges
Addressing these disparities requires a multi-faceted approach involving healthcare providers, policymakers, and community organizations. Some potential strategies include:
- Implementing targeted outreach programs to connect vulnerable populations with cancer screening and treatment services.
- Providing financial assistance and transportation support to help patients overcome barriers to care.
- Promoting culturally sensitive healthcare practices to ensure that all patients receive appropriate and respectful care.
- Expanding access to telehealth services to reach patients in rural or underserved areas.
- Advocating for policies that address social determinants of health, such as poverty, housing instability, and food insecurity.
