Social and economic
factors tied to pancreatic cancer surgery, survival
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[November 20, 2015] By
Andrew M. Seaman
(Reuters Health) - Social and economic
factors may influence who is most likely to get surgery for early-stage
pancreas cancer, a new U.S. study suggests, and eliminating these gaps
could improve outcomes, the authors say.
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Factors such as race, marital status, insurance coverage and region
were linked to the odds someone with pancreas cancer would get
surgery to remove the tumor, as well as how advanced their tumor was
when diagnosed. People who got surgery tended to live much longer
than those who didn't.
"It likely indicates that efforts to improve outcomes for pancreas
cancer are best aimed at eliminating disparities in access and
utilization of resection for early-stage pancreas cancer," said
senior author Dr. Jason Gold, of Harvard Medical School and the VA
Boston Healthcare System.
Cancer of the pancreas, a gland that produces hormones, has
notoriously poor outcomes, with only 7 percent of patients surviving
five years after diagnosis, Gold and colleagues write in JAMA
Surgery.
They add that resection, which is surgery to remove the cancer, is
one of the most important factors in determining how someone with
pancreas cancer fares.
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For the new study, the researchers looked at what factors are tied
to people with pancreas cancer getting resections, and whether those
factors are also linked to how long a person lives after surgery.
They used data from 17,530 people diagnosed with pancreas cancer in
the U.S. between 2004 and 2011.
About 45 percent received resections, and that rate did not change
throughout the study period. But people who were white,
non-Hispanic, married, insured and living in the Northeast had
higher odds of having resections.
Those who had the surgery ended up living an average of 21 months
after diagnosis, compared to an average of six months for those who
didn't get resections.
The researchers found that although many factors were tied to the
odds of getting surgery, among those who did have resections, only
one of those factors was also independently linked to survival
afterwards - geographic location.
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People who had resections and lived in Northeast, Pacific West or
the Midwest tended to live longer than those who lived in the
Southeast.
While the study can't determine why location is tied to better
survival after surgery, the researchers say there are a few possible
explanations. One is that hospitals in the Southeast may not perform
as many pancreas resections as hospitals in other parts of the
country and that difference may influence the surgery outcomes.
The study is also limited by a lack of information on factors that
may determine whether a person's cancer can be operated on, write
Drs. Daniel Anaya and Makenge Malafa of H. Lee Moffitt Cancer Center
and Research Institute in Tampa, Florida, in a commentary
accompanying the study.
But, Anaya and Malafa add, the findings point to what can be done to
improve survival for all pancreatic cancer patients.
Gold also told Reuters Health that future research should focus on
improving access to surgery for all patients with early-stage
pancreas cancer.
SOURCE: http://bit.ly/1I0aCI9 and http://bit.ly/1I0aDff JAMA
Surgery, online November 19, 2015.
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