Title

Closing the Gap on Racial Disparities in Pancreas Cancer -the Impact of a Multidisciplinary Clinic for Surgical Patients with Pancreatic Adenocarcinoma (PDAC) in an Integrated, Tertiary Healthcare System

Document Type

Conference Proceeding

Publication Date

3-1-2023

Publication Title

Ann Surg Oncol

Abstract

INTRODUCTION: Studies have highlighted disparate outcomes for African American (AA) patients undergoing treatment for PDAC. Tumor biology and social determinants of health are known to impact outcomes. However, the impact of multidisciplinary care is not well understood. We hypothesized that attending a single-day multidisciplinary clinic (MDC) consisting of access to medical, radiation, and surgical oncology, nurse navigation, and supportive services positively impacts outcomes of AA patients undergoing surgery for PDAC.

METHODS: Retrospective analysis of patients with surgically resected PDAC was conducted between January 2013 and June 2022. Demographics, treatment modality, operative, and pathological features were compared between surgical patients evaluated in MDC to those that were not. Patients were stratified by race, and overall survival outcomes were compared. Kaplan-Meier and Cox regression models were utilized.

RESULTS: 187 patients underwent surgery for PDAC between 2013 and 2022, of which 67.9% (N=127) were evaluated in MDC. AA patients constituted 19.7% of patients evaluated in MDC (25/127); there were 13 of 60 AA patients not evaluated in MDC. Patients evaluated in MDC were younger (63 vs. 67 yo, p=0.016), more likely to have their case discussed in tumor board (p=0.044), receive neoadjuvant therapy (p=0.001), and operated on by a fellowship-trained surgical oncologist (p< 0.001). There were no differences in final pathologic stage, resection margin, LVI and perineural invasion; however, patients seen in MDC had lower positive lymph nodes (p=0.026). Median overall survival (OS) was higher in patients managed in MDC than those who were not (48 vs. 34.9 mo., p=0.057). There was no statistical significance in median OS between AA and non-AA patients who attended MDC (55.9 vs. 47 mo., p=0.234).

CONCLUSIONS: Our data suggests that evaluation and management in an MDC confers a survival advantage for patients undergoing pancreas surgery for PDAC. Moreover, when introduced across a diverse patient population in an integrated health care system, MDC was shown to reduce the survival gap between AA and non-AA patients. For AA patients, this data suggests that perhaps overcoming certain social determinants of health and access may play a more significant role than underlying differences in tumor biology.

Volume

30

First Page

S233

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