OBJECTIVES

Pancreatic cancer is the fourth leading cause of cancer mortality in the U.S., with an estimated 47,050 deaths in 2020. Surgical resection is the only potentially curative treatment; however, less than 20% of patients are eligible due to advanced stage. Racial disparities in pancreatic resection are well documented. However, little is known about whether racial disparities exist in elderly patients. This study examines the relationship between race/ethnicity and resection among elderly pancreatic cancer patients.

METHODS

A retrospective cohort study was conducted using the national Surveillance Epidemiology and End Results Program data. The patient population was 65 years and older, diagnosed with resectable pancreatic cancer (stage I and II) between 2007 and 2016. Chi-square tests were used to describe patient demographics, and multiple logistic regression was used to assess the association between race/ethnicity and receipt of resection.

RESULTS

Among 12,829 patients included for the analysis (mean [SD] age, 76 [7.5] years), the majority were white (73.1%), followed by Hispanic (9.3%), black (9.1%), and other (American Indian, Asian/Pacific Islander) (8.6%). In stage II cancer patients, black patients received significantly less resection compared to white patients (45.1% vs. 53.7%, p<0.0001). Across stage I and II, the odds of resection among black and Hispanic patients were lower compared to white patients (OR 0.69; 95%CI 0.60-0.80, and OR 0.78; 95% CI 0.68-0.90, respectively), while it was not significantly different for American Indian and Asian/Pacific Islander.

CONCLUSIONS

Our results support that, among elderly pancreatic cancer patients, black and Hispanic patients were less likely to receive resection than white patients, despite being eligible for surgery. This suggests that racial disparities in resection rate seen among younger adults (age <65) continue in the elderly populations. Further studies are needed to understand the mechanisms of the disparities and to identify the mediators within racial/ethnic groups that can be targeted for intervention.