Investigators may have uncovered factors that may impact the quality of cancer care and outcomes among patients with metastatic pancreatic ductal adenocarcinoma, according to a recent study published by Tsilimigras et al in JNCCN–Journal of the National Comprehensive Cancer Network.
Study Methods and Results
In this study, investigators used the Surveillance, Epidemiology, and End Results–Medicare database to examine the outcomes of 14,147 patients who were diagnosed with metastatic pancreatic ductal adenocarcinoma between 2005 and 2019. Quality-of-care scores were determined based on the receipt of guideline-concordant systemic therapy, palliative care, and a cancer-specific survival of more than 12 months.
The study authors found that the patients with a higher measure on the Social Vulnerability Index were 30% less likely to experience at least one of the three quality indicators. Of note, when race and socioeconomic status were separated, the patients who were a member of an underserved racial or ethnic group were 25% less likely to experience one or more quality indicators, regardless of their income. Lower socioeconomic status correlated with a 34% reduced likelihood of experiencing a quality indicator, independent of race.
In addition, the investigators revealed that the patients who did receive appropriate systemic and/or palliative care were more likely to survive more than 1 year after being diagnosed. They noted improvements over time across the study period in both quality scores and longevity.
“Ensuring that all patients, regardless of their background, receive guideline-concordant care is important to improve outcomes for patients with metastatic pancreatic [ductal adenocarcinoma],” stressed senior study author Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, of The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center. “We found that while adherence to [National Comprehensive Cancer Center] Guidelines improved over time, there remain significant disparities in the receipt of guideline-concordant care among patients with metastatic pancreatic [ductal adenocarcinoma], which can, in turn, affect outcomes,” he suggested.
Conclusions
“The results of our study highlight the need for targeted interventions to mitigate disparities in cancer care,” emphasized lead study author Diamantis Tsilimigras, MD, PhD, of The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center. “Federal policies that expand Medicaid or possibly expand Medicare coverage for palliative care can help reduce disparities. Furthermore, policies that address social determinants of health—including financial aid for the most vulnerable populations as well as understanding and addressing potential implicit biases relative to treatment recommendations—could help address disparities in equal access to care,” he added.
Jason S. Gold, MD, Associate Professor, Surgery, Harvard Medical School—who was not involved in this research—shared these comments: “There is increasing recognition of the persistence of disparities in treatment and outcomes for pancreatic cancer,” he said. “This study adds to this body of knowledge by showing that social vulnerability, unmarried status, and lower income were all independently associated with lower quality care for metastatic pancreatic ductal adenocarcinoma.”
Disclosure: For full disclosures of the study authors, visit jnccn.org.
