Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3427–3435 | Cite as

Race and Health Disparities in Patient Refusal of Surgery for Early-Stage Pancreatic Cancer: An NCDB Cohort Study

  • Samer TohmeEmail author
  • Christof Kaltenmeier
  • Patrick Bou-Samra
  • Patrick R. Varley
  • Allan Tsung
Health Services Research and Global Oncology



To identify factors associated with refusal of surgery in patients with early-stage pancreatic cancer and estimate the impact of this decision on survival.


Using the National Cancer Data Base, 26,358 patients were identified with potentially resectable tumors (pretreatment clinical stage I: T1 or T2 N0M0). Multivariate models were employed to identify factors predicting failure to undergo surgery and assess the impact on survival.


Of early-stage patients who were recommended surgery, 7.8% (N = 992) refused surgery for resectable early-stage pancreatic cancer. On multivariable analysis, patients were more likely to refuse surgery if they were older [odds ratio (OR) = 1.18; 95% confidence interval (CI) 1.16–1.19], female (OR = 1.52; 95% CI 1.33–1.73), African American (vs White, OR = 1.79; 95% CI 1.37–2.34), on Medicare/Medicaid (vs private, OR = 2.75; 95% CI 1.54–4.92) or had higher Charlson–Deyo score (2 vs 0, OR = 1.33; 95% CI 1.03–1.72). Patients were also significantly more likely to refuse surgery if they were seen at a center that is not an academic/research program (OR 1.9; 95% CI 1.6–2.27). Patients who were recommended surgery but refused had significantly worse survival than those with stage I who received surgery [median survival 6.8 vs 24 months, Cox hazard ratio (HR) 3.41; 95% CI 3.12–3.60].


The percentage of patients refusing surgery for operable early-stage pancreatic cancer has been decreasing in the last decade but remains a significant issue that affects survival. Disparities in refusal of surgery are independently associated with several variables including gender, race, and insurance. To mitigate national disparities in surgical care, future studies should focus on exploring potential reasons for refusal and developing communication interventions.

Supplementary material

10434_2018_6680_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 37 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Samer Tohme
    • 1
    Email author
  • Christof Kaltenmeier
    • 1
  • Patrick Bou-Samra
    • 1
  • Patrick R. Varley
    • 1
  • Allan Tsung
    • 1
  1. 1.Department of General SurgeryUniversity of PittsburghPittsburghUSA

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