Study Suggests Racial Inequalities in VA Pancreatic Cancer Care

BACKGROUND:
The prevalence of pancreatic cancer is increasing in the U.S., and the only chance for long-term survival is with early diagnosis and potentially curative surgery. Moreover, evidence from U.S. studies conducted in the private healthcare sector suggests stark racial disparities in pancreatic cancer care, with Black patients having the highest incidence of pancreatic cancer of any racial group, yet the lowest treatment rates and poorest outcomes. The VA healthcare system offers equal access for all patients. Therefore, using VA data, this study examined whether there were significant racial disparities in the continuum of pancreatic cancer care in the VA system, hypothesizing that there would be no racial disparities in the receipt of pancreatic cancer care among Black and White Veterans. Study investigators identified all Veterans diagnosed with pancreatic adenocarcinoma in the national VA Central Cancer Registry (CCR) from January 2010 to December 2018 (n=8,529; 80% white, 21% black). They then examined the independent association between race and three endpoints: 1) stage at diagnosis; 2) receipt of treatment (surgical resection – or surgical resection combined with chemotherapy and/or radiation therapy); and 3) survival, while adjusting for sociodemographic factors and medical comorbidities (i.e., BMI, tobacco and alcohol use, and type 2 diabetes).

FINDINGS:

• Study results indicate that even in a healthcare system with equal access to care, racial inequalities exist in the timing of pancreatic cancer diagnosis and receipt of treatment. Black Veterans were 19% more likely to have late-stage disease and 25% less likely to undergo surgical resection.
• After adjusting for sociodemographic characteristics and medical comorbidities, Black Veterans had 13% higher mortality risk compared to White Veterans. However, this was no longer statistically significant after additionally adjusting for cancer stage and receipt of potentially curative treatment.
• Compared with White Veterans in this study, Black Veterans were more likely to be younger, have lower VA priority group status, live in urban (vs. rural) areas, have lower BMIs, be current tobacco or alcohol users, and have type 2 diabetes.

IMPLICATIONS:

• Though overall survival rates did not differ significantly by race, likely due to the highly fatal nature of the disease, major breakthroughs in pancreatic cancer treatment are likely to be seen in next 5-10 years. This will make efforts to improve the timing of pancreatic cancer diagnosis and treatment initiation all the more important for reducing racial disparities in cancer care.

LIMITATIONS:

• Investigators were unable to include Hispanic patients given the limited sample size.
• The database may not have included potential confounders not routinely captured from clinical data.

AUTHOR/FUNDING INFORMATION:
Drs. Khalaf, Wenker, Kramer, Singh, and Kanwal are part of HSR&D’s Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) in Houston, TX. Dr. Khalaf is supported by an HSR&D Career Development Award.

Khalaf N, Xu A, Wenker T, Kramer J, et al. The Impact of Race on Pancreatic Cancer Treatment and Survival in the Nationwide Veterans Affairs Healthcare System. Pancreas. November 13, 2023; online ahead of print.