Quality Score Among Patients With Metastatic Pancreatic Ductal Adenocarcinoma: Trends, Racial Disparities, and Impact on Outcomes
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Background: Evaluation of the quality of care delivered to patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) has been limited. We sought to examine trends and racial/ethnic disparities in quality of care among patients with mPDAC as well as the impact on outcomes using a novel and easily applied quality metric. Methods: Medicare beneficiaries diagnosed with mPDAC between 2005 and 2019 were identified using SEER-Medicare data. Achievement of a quality score based on 3 criteria was assessed: (1) cancer-specific survival (CSS) >12 months, (2) receipt of systemic therapy, and (3) utilization of hospice/palliative care services. We examined factors associated with achieving the quality score, including race/ethnicity, social vulnerability index (SVI), and year of treatment. The impact of the quality score on CSS was also analyzed. Results: Among 14,147 patients with mPDAC, 62.2% (n=8,794) received systemic therapy, 83.3% (n=11,791) utilized palliative care/hospice services, and 13.7% (n=1,933) had CSS >12 months after diagnosis. Achievement of at least one quality criterion increased over time (from 84.5% in 2005 to 97.0% in 2019; P<.001). Multivariable analysis showed that a high overall SVI (odds ratio [OR], 0.70; 95% CI, 0.54–0.91) was independently associated with lower odds of meeting at least one quality criterion. This effect was mainly driven by the SVI subthemes of high socioeconomic status (OR, 0.66; 95% CI, 0.48–0.90) and high racial/ethnic minority status (OR, 0.75; 95% CI, 0.60–0.93). Achievement of quality score ≥1 (excluding CSS criterion) was associated with improved overall survival (1-year CSS, 14.5% vs 3.2%; P<.001). Conclusions: Approximately 9 in 10 patients with mPDAC achieved at least one of the quality score criteria, though racial/ethnic minority patients and socially vulnerable populations had lower achievement. Lower quality score achievement was associated with poorer long-term survival. These findings highlight the need for targeted interventions to meet quality metrics for all patients with mPDAC to mitigate disparities in end-of-life care.
Submitted June 30, 2024; final revision received October 19, 2024; accepted for publication November 14, 2024.
Author contributions: Concept & design: All authors. Analysis: Tsilimigras, Woldesenbet. Writing—original draft: All authors. Writing—review & editing: All authors.
Data availability statement: The data for this study was sourced from the linked SEER-Medicare database. There are restrictions to the availability of this data which is used under license for this study. Permission to access the data can be obtained from the National Cancer Institute and the Center for Medicare & Medicaid Services.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s SEER Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute.
Disclaimer: The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, or the Centers for Disease Control and Prevention or their contractors and subcontractors.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7089. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
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