Treatment Inequity: Examining the Influence of Non-Hispanic Black Race and Ethnicity on Pancreatic Cancer Care and Survival in Wisconsin

Andrea M. Schiefelbein, MSPH; John K. Krebsbach, BS; Amy K. Taylor, MD; Jienian Zhang, MS; Chloe E. Haimson, MS; Amy Trentham-Dietz, PhD; Melissa C. Skala, PhD; John M. Eason, PhD; Sharon M. Weber, MD; Patrick R. Varley, MD, MS; Syed Nabeel Zafar, MD, MPH; Noelle K. LoConte, MD

WMJ. 2022;121(2):77-85,93

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ABSTRACT

Introduction: We investigated race and ethnicity-based disparities in first course treatment and overall survival among Wisconsin pancreatic cancer patients.

Methods: We identified adults diagnosed with pancreatic adenocarcinoma in the Wisconsin Cancer Reporting System from 2004 through 2017. We assessed race and ethnicity-based disparities in first course of treatment via adjusted logistic regression and overall survival via 4 incremental Cox proportional hazards regression models.

Results: The study included 8,490 patients: 91.3% (n = 7,755) non-Hispanic White; 5.1% (n = 437) non-Hispanic Black, 1.7% (n = 141) Hispanic, 0.6% Native American (n = 53), and 0.6% Asian (n = 51) race and ethnicities. Non-Hispanic Black patients had lower odds of treatment than non-Hispanic White patients for full patient (OR, 0.52; 95% CI, 0.41-0.65) and Medicare cohorts (OR, 0.40; 95% CI, 0.29-0.55). Non-Hispanic Black patients had lower odds of receiving surgery than non-Hispanic White patients (full cohort OR, 0.67 [95% CI, 0.48-0.92]; Medicare cohort OR, 0.57 [95% CI, 0.34-0.93]). Non-Hispanic Black patients experienced worse survival than non-Hispanic White patients in the first 2 incremental Cox proportional hazard regression models (model II HR, 1.18; 95% CI, 1.06-1.31). After adding insurance and treatment course, non-Hispanic Black and non-Hispanic White patients experienced similar survival (HR, 0.98; 95% CI, 0.88-1.09).

Conclusion: Non-Hispanic Black patients were almost 50% less likely to receive any treatment and 33% less likely to receive surgery than non-Hispanic White patients. After including treatment course, non-Hispanic Black and non-Hispanic White patient survival was similar. Increasing non-Hispanic Black patient treatment rates by addressing structural factors affecting treatment availability and employing culturally humble approaches to treatment discussions may mitigate these disparities.

Author Affiliations: Morgridge Institute for Research, Madison, Wisconsin (Schiefelbein, Skala); Dept of Medicine, University of Wisconsin (UW) School of Medicine and Public Health (SMPH), Madison, Wis (Taylor, LoConte); Dept of Sociology, UW-Madison, Madison, Wis (Zhang, Haimson, Eason); UW Carbone Cancer Center, Madison, Wis (Krebsbach, Taylor, Trentham-Dietz, Skala, Eason, Weber, Varley, Zafar); Dept of Population Health Sciences, UW–Madison, Madison, Wis (Trentham-Dietz, LoConte); Dept of Biomedical Engineering, UW–Madison, Wis (Skala); Dept of Community and Environmental Sociology, UW–Madison, Madison, Wis (Eason); Institute for Research on Poverty, UW–Madison, Madison, Wis (Eason); Dept of Surgical Oncology, UW SMPH, Madison, Wis (Varley, Zafar).
Corresponding Author: Noelle LoConte, MD, 600 Highland Ave, CSC K4/538 M/C 5666, Madison, WI 53792; email ns3@medicine.wisc.edu; ORCID ID 0000-0002-3883-4153.
Acknowledgements: The authors would like to thank the University of Wisconsin Carbone Cancer Center Pancreas Cancer Task Force for the funds to complete this project. A virtual poster based on preliminary work was presented at the 2020 American Association of Cancer Research Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved conference.
Funding/Support: This project was supported by P30 CA014520 (CCSG Cancer Center Support Grant, University of Wisconsin Carbone Cancer Center), R01 CA211082 (NIH/NCI), R01 CA211082-03S1 (NIH/NCI), and the University of Wisconsin Carbone Cancer Center Pancreas Cancer Task Force.
Financial Disclosures: None declared.

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