Disparities in Treatment/Survival Outcomes Observed in Metastatic PDAC

In patients who achieved a quality score of at least 1 compared with those who had a score of 0, the median age was younger, at 68 years vs 72 years, and those achieving a quality score of at least 1 were more likely to be female at 53.3% vs 46.7% who were male patients.

Patients with metastatic pancreatic ductal adenocarcinoma (PDAC) classified as racial or ethnic minority individuals or as socially vulnerable had lower quality of care, which resulted in suboptimal treatment and survival outcomes, according to findings from a study published in the Journal of the National Comprehensive Cancer Network.¹

Findings from the study revealed that key quality score indicators frequently disfavored those with a higher social vulnerability index (SVI), a composite measure with higher measures indicating greater vulnerability, encompassing factors such as socioeconomic status, household characteristics, racial and ethnic minority status, as well as housing or transportation type.

Data showed that patients with a quality score of 1 or greater compared with those who had a quality score of 0 were more likely to be White (79.4% vs 70.2%), have low SVI (32.1% vs 22.5%), and reside in areas with the highest median household income (top quartile for household income: 24.1% vs 19.2%).

Furthermore, multivariate analysis revealed that higher SVI was independently associated with 28% lower odds of receiving palliative or hospice services (OR, 0.72; 95% CI, 0.61-0.85), 12% lower odds of receiving systemic therapy (OR, 0.88; 95% CI, 0.77-0.99), and a 30% lower chance of receiving a quality score of at least 1 (OR, 0.70; 95% CI, 0.54-0.91).

“The results of our study highlight the need for targeted interventions to mitigate disparities in cancer care,” lead author Diamantis Tsilimigras, MD, PhD, a general surgery resident at The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, said in a news release on the study.² “Federal policies that expand Medicaid or possibly expand Medicare coverage for palliative care can help reduce disparities. Furthermore, policies that address social determinants of health—including financial aid for the most vulnerable populations as well as understanding and addressing potential implicit biases relative to treatment recommendations—could help address disparities in equal access to care.”

Investigators of the study derived data from the Surveillance, Epidemiology, and End Results database, which captures data from approximately 95% of patients 65 years or older and matches them with Medicare claims files. Those diagnosed with stage IV PDAC between 2005 and 2019 were included for analysis. Additionally, patients were required to have Medicare part A and B coverage for at least 1 year before enrollment, effectively excluding those younger than 66 years.

The study population encompassed 14,147 Medicare beneficiaries with metastatic PDAC, with a median age of 68 years (IQR, 66-74). Most patients were White (78.8%) and female (52.9%), and had a Charlson comorbidity index (CCI) score of 6 (86.5%). A total of 13.7% of this patient population had a cancer-specific survival (CSS) of at least 12 months, 62.2% received systemic therapy, and 83.3% received palliative care and/or hospice services. Furthermore, 93.3% of patients achieved a quality score of 1 or greater.

The primary outcome of the study was metastatic PDAC score, defined as meeting at least one of the following criteria: receipt of systemic therapy in alignment with guidelines, receipt of palliative care or hospice services, and CSS for more than 12 months.

Further data from the trial revealed that in patients who achieved a quality score of at least 1 compared with those who had a score of 0, the median age was younger at 68 years vs 72 years. Additionally, those achieving a quality score of at least 1 were more likely to be female at 53.3% vs 46.7% who were male patients. Additionally, 56.1% of patients who achieved a quality score of at least 1 were married vs 40.3% for those not married, and a greater proportion of patients with a CCI score lower than 6 achieved a quality score of at least 1.

“Ensuring that all patients, regardless of their background, receive guideline-concordant care is important to improve outcomes for patients with metastatic pancreatic cancer,” senior author Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, surgical oncology specialist at The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, expressed in the news release.² “We found that while adherence to NCCN guidelines improved over time, there remain significant disparities in the receipt of guideline-concordant care among patients with metastatic pancreatic cancer, which can, in turn, affect outcomes.”

References

1. Tsilimigras DI, Woldesenbet S, Waterman BL, Noonan AM, Pawlik TM. Quality score among patients with metastatic pancreatic ductal adenocarcinoma: trends, racial disparities, and impact on outcomes. J Natl Compr Canc Netw. 2025;23(4):e247089. doi:10.6004/jnccn.2024.7089
2. New research in JNCCN finds stark disparities in treatment and survival time for people with pancreatic cancer. News release. NCCN. April 9, 2025. Accessed April 10, 2025. https://tinyurl.com/39v4uyju