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Del Valle JP, Fillmore NR, Molina G, et al. Socioeconomic Disparities in Pancreas Cancer Resection and Survival in the Veterans Health Administration. Ann Surg Oncol. 2022;doi: 10.1245/s10434-021-11250-0.
Del Valle, J. P., Fillmore, N. R., Molina, G., Fairweather, M., Wang, J., Clancy, T. E., Ashley, S. W., Urman, R. D., Whang, E. E., & Gold, J. S. (2022). Socioeconomic Disparities in Pancreas Cancer Resection and Survival in the Veterans Health Administration. Annals of surgical oncology, . https://doi.org/10.1245/s10434-021-11250-0
Del Valle, Jonathan Pastrana, et al. "Socioeconomic Disparities in Pancreas Cancer Resection and Survival in the Veterans Health Administration." Annals of surgical oncology vol. (2022). doi: https://doi.org/10.1245/s10434-021-11250-0
Del Valle JP, Fillmore NR, Molina G, Fairweather M, Wang J, Clancy TE, Ashley SW, Urman RD, Whang EE, Gold JS. Socioeconomic Disparities in Pancreas Cancer Resection and Survival in the Veterans Health Administration. Ann Surg Oncol. 2022 Jan 10; doi: 10.1245/s10434-021-11250-0. Epub 2022 Jan 10. PMID: 35006509.
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Ann Surg Oncol. 2022 Jan 10; doi: 10.1245/s10434-021-11250-0. Epub 2022 Jan 10.

Socioeconomic Disparities in Pancreas Cancer Resection and Survival in the Veterans Health Administration.

Annals of surgical oncology

Jonathan Pastrana Del Valle, Nathanael R Fillmore, George Molina, Mark Fairweather, Jiping Wang, Thomas E Clancy, Stanley W Ashley, Richard D Urman, Edward E Whang, Jason S Gold

Affiliations

  1. Surgical Service, VA Boston Healthcare System, West Roxbury, MA, USA.
  2. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
  3. Harvard Medical School, Boston, MA, USA.
  4. Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Jamaica Plain, MA, USA.
  5. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
  6. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  7. Surgical Service, VA Boston Healthcare System, West Roxbury, MA, USA. [email protected].
  8. Harvard Medical School, Boston, MA, USA. [email protected].
  9. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. [email protected].

PMID: 35006509 DOI: 10.1245/s10434-021-11250-0

Abstract

BACKGROUND: Disparities based on socioeconomic factors such as race, ethnicity, marital status, and insurance status are associated with pancreatic cancer resection, but these disparities are usually not observed for survival after resection. It is unknown if there are disparities when patients undergo their treatment in a non-fee-for-service, equal-access healthcare system such as the Veterans Health Administration (VHA).

METHODS: Patients having T1-T3 M0 pancreatic adenocarcinoma diagnosed between 2006 and 2017 were identified from the VHA Corporate Data Warehouse. Socioeconomic, demographic, and tumor variables associated with resection and survival were assessed.

RESULTS: In total, 2580 patients with early-stage pancreatic cancer were identified. The resection rate was 36.5%. Surgical resection was independently associated with younger age [odds ratio (OR) 0.94, p < 0.001], White race (OR 1.35, p = 0.028), married status (OR 1.85, p = 0.001), and employment status (retired vs. unemployed, OR 1.41, p = 0.008). There were no independent associations with Hispanic ethnicity, geographic region, or Social Deprivation Index. Resection was associated with significantly improved survival (median 21 vs. 8 months, p = 0.001). Among resected patients, survival was independently associated with younger age (HR 1.019, p = 0.002), geographic region (South vs. Pacific West, HR 0.721, p = 0.005), and employment (employed vs. unemployed, HR 0.752, p = 0.029). Race, Hispanic ethnicity, marital status, and Social Deprivation Index were not independently associated with survival after resection.

CONCLUSIONS: Race, marital status, and employment status are independently associated with resection of pancreatic cancer in the VHA, whereas geographic region and employment status are independently associated with survival after resection. Further studies are warranted to determine the basis for these inequities.

© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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