Sociodemographic Disparities in the Receipt of Adjuvant Chemotherapy Among Patients With Resected Stage I–III Pancreatic Adenocarcinoma

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Background: Adjuvant therapy for resected pancreatic adenocarcinoma was given a category 1 NCCN recommendation in 2000, yet many patients do not receive chemotherapy after definitive surgery. Whether sociodemographic disparities exist for receipt of adjuvant chemotherapy is poorly understood. Methods: The National Cancer Database was used to identify patients diagnosed with nonmetastatic pancreatic adenocarcinoma who underwent definitive surgery from 2004 through 2015. Multivariable logistic regression defined the adjusted odds ratio (aOR) and associated 95% CI of receipt of adjuvant chemotherapy. Among patients receiving chemotherapy, multivariable logistic regression assessed the odds of treatment with multiagent chemotherapy. Results: Among 18,463 patients, 11,288 (61.1%) received any adjuvant chemotherapy. Sociodemographic factors inversely associated with receipt of any adjuvant chemotherapy included uninsured status (aOR, 0.61; 95% CI, 0.50–0.74), Medicaid insurance (aOR, 0.66; 95% CI, 0.57–0.77), and lower income (P<.001 for all income levels compared with ≥$46,000). Black race (aOR, 0.72; 95% CI, 0.57–0.90) and female sex (aOR, 0.75; 95% CI, 0.65–0.86) were associated with lower odds of receiving multiagent chemotherapy. There was a statistically significant interaction term between black race and age/comorbidity status (P=.03), such that 26.4% of black versus 35.8% of nonblack young (aged ≤65 years) and healthy (Charlson-Deyo comorbidity score 0) patients received multiagent adjuvant chemotherapy (P=.006), whereas multiagent adjuvant chemotherapy rates were similar among patients who were not young and healthy (P=.15). Conclusions: In this nationally representative study, receipt of adjuvant chemotherapy appeared to be associated with sociodemographic characteristics, independent of clinical factors. Sociodemographic differences in receipt of adjuvant chemotherapy may represent a missed opportunity for improving outcomes and a driver of oncologic disparities.

Submitted March 9, 2019; accepted for publication May 17, 2019.Author contributions: Study concept: Sanford, Mahal, Sher. Data acquisition and analysis: Sanford, Sher. Methodology: Sanford, Aguilera, Folkert, Ahn, Mahal, Zeh, Beg, Mansour, Sher. Manuscript writing: Sanford, Sher. Manuscript review and editing: Aguilera, Folkert, Ahn, Mahal, Zeh, Beg, Mansour.Disclosures: Dr. Mahal has disclosed that he receives funding from the American Society of Radiation Oncology and the Prostate Cancer Foundation. The remaining authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.Correspondence: Nina N. Sanford, MD, Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX 75390-9303. Email: nina.sanford@utsouthwestern.edu

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