Annals of Surgical Oncology

, Volume 20, Issue 13, pp 4073–4079 | Cite as

Race Does Not Impact Pancreatic Cancer Treatment and Survival in an Equal Access Federal Health Care System

  • Sukhyung LeeEmail author
  • Jeffrey L. Reha
  • Ching-Wei D. Tzeng
  • Nader N. Massarweh
  • George J. Chang
  • Stephen P. Hetz
  • Jason B. Fleming
  • Jeffrey E. Lee
  • Matthew H. Katz
Healthcare Policy and Outcomes



Black patients with pancreatic adenocarcinoma (PDAC) have been reported to undergo surgical resection less frequently and to have a shorter overall survival duration than white patients. We sought to determine whether disparities in clinical management and overall survival exist between black and white patients with PDAC treated in an equal access health care system.


Using the Department of Defense (DoD) tumor registry database from 1993 to 2007, patient, tumor, and treatment factors were analyzed to compare rates of therapy and survival between black and white patients.


Of 1,008 patients with PDAC, 157 were black (15 %). Thirty-six percent of black and 37 % of white patients presented with locoregional disease (p = 0.85). Among those with locoregional cancers, the odds of black patients having received surgical resection (odds ratio [OR] 1.06, 95 % confidence interval [CI] 0.60–1.89), chemotherapy (OR 0.92, 95 % CI 0.49–1.73) and radiotherapy (OR 1.14, 95 % CI 0.61–2.10) were not different from those of whites. Among those with distant disease, the odds of having received palliative chemotherapy were also similar (OR 0.91, 95 % CI 0.55–1.51). Black and white patients with PDAC had a similar median overall survival. In a multivariate analysis, as compared to whites, black race was not associated with shorter overall survival.


We observed no disparities in either management or survival between white and black patients with PDAC treated in the DoD’s equal access health care system. These data suggest that improving the access of minorities with PDAC to health care may reduce disparities in their oncologic outcomes.


Pancreatic Cancer Racial Disparity Black Patient White Patient Distant Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Agency for Healthcare Research and Quality. 2011 national healthcare quality and disparities reports. Accessed Jan 31 2013.
  2. 2.
    Riall TS, Townsend CM Jr, Kuo YF, Freeman JL, Goodwin JS. Dissecting racial disparities in the treatment of patients with locoregional pancreatic cancer: a 2-step process. Cancer. 2010;116:930–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Murphy MM, Simons JP, Hill JS, et al. Pancreatic resection: a key component to reducing racial disparities in pancreatic adenocarcinoma. Cancer. 2009;115:3979–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Revels SL, Banerjee M, Yin H, Sonnenday CJ, Birkmeyer JD. Racial disparities in surgical resection and survival among elderly patients with poor prognosis cancer. J Am Coll Surg. 2013;216:312–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Eloubeidi MA, Desmond RA, Wilcox CM, et al. Prognostic factors for survival in pancreatic cancer: a population-based study. Am J Surg. 2006;192:322–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Murphy MM, Simons JP, Ng SC, et al. Racial differences in cancer specialist consultation, treatment, and outcomes for locoregional pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:2968–77.PubMedCrossRefGoogle Scholar
  7. 7.
    Singal V, Singal AK, Kuo YF. Racial disparities in treatment for pancreatic cancer and impact on survival: a population-based analysis. J Cancer Res Clin Oncol. 2012;138:715–22.PubMedCrossRefGoogle Scholar
  8. 8.
    Jinjuvadia R, Jinjuvadia K, Liangpunsakul S. Racial disparities in gastrointestinal cancers—related mortality in the U.S. population. Dig Dis Sci. 2013;58:236–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Davila JA, Chiao EY, Hasche JC, Petersen NJ, McGlynn KA, Shaib YH. Utilization and determinants of adjuvant therapy among older patients who receive curative surgery for pancreatic cancer. Pancreas. 2009;38:e18–25.PubMedCrossRefGoogle Scholar
  10. 10.
    Sehgal AR. Universal health care as a health disparity intervention. Ann Intern Med. 2009;150:561–2.PubMedCrossRefGoogle Scholar
  11. 11.
    Military medical care: questions and answers. February 28, 2013. Accessed May 9, 2013.
  12. 12.
    Employer Health Benefits Survey 2012. Accessed May 10, 2013.
  13. 13.
    Bagchi AD, Schone E, Higgins P, Granger E, Casscells SW, Croghan T. Racial and ethnic health disparities in TRICARE. J Natl Med Assoc. 2009;101:663–70.PubMedGoogle Scholar
  14. 14.
    North American Association of Central Cancer Registries Inc. 2013 implementation guidelines and recommendations. Accessed Jan 31, 2013.
  15. 15.
    Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS. National failure to operate on early stage pancreatic cancer. Ann Surg. 2007;246:173–80.PubMedCrossRefGoogle Scholar
  16. 16.
    Shone LP, Dick AW, Klein JD, Zwanziger J, Szilagyi PG. Reduction in racial and ethnic disparities after enrollment in the State Children’s Health Insurance Program. Pediatrics. 2005;115:e697–705.PubMedCrossRefGoogle Scholar
  17. 17.
    McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Health of previously uninsured adults after acquiring Medicare coverage. JAMA. 2007;298:2886–94.PubMedCrossRefGoogle Scholar
  18. 18.
    McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of medicare coverage. Ann Intern Med. 2009;150:505–15.Google Scholar
  19. 19.
    Hyman JJ, Reid BC, Mongeau SW, York AK. The military oral health care system as a model for eliminating disparities in oral health. J Am Dent Assoc. 2006;137:372–8.PubMedGoogle Scholar
  20. 20.
    Gao SW, Oliver DK, Das N, et al. Assessment of racial disparities in chronic kidney disease stage 3 and 4 care in the Department of Defense Health System. Clin J Am Soc Nephrol. 2008;3:442–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Mulligan CR, Meram AD, Proctor CD, Wu H, Zhu K, Marrogi AJ. Unlimited access to care: effect on racial disparity and prognostic factors in lung cancer. Cancer Epidemiol Biomarkers Prev. 2006;15:25–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Bagchi AD, Stewart K, McLaughlin C, Higgins P, Croghan T. Treatment and outcomes for congestive heart failure by race/ethnicity in TRICARE. Med Care. 2011;49:489–95.PubMedCrossRefGoogle Scholar
  23. 23.
    Hofmann LJ, Lee S, Waddell B, Davis KG. Effect of race on colon cancer treatment and outcomes in the Department of Defense Healthcare System. Dis Colon Rectum. 2010;53:9–15.PubMedCrossRefGoogle Scholar
  24. 24.
    Brown SR, Lee S, Brown TA, Waddell BE. Effect of race on thyroid cancer care in an equal access healthcare system. Am J Surg. 2010;199:685–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Albain KS, Unger JM, Crowley JJ, Coltman CA Jr, Hershman DL. Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst. 2009;101:984–92.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Sukhyung Lee
    • 1
    Email author
  • Jeffrey L. Reha
    • 2
  • Ching-Wei D. Tzeng
    • 1
  • Nader N. Massarweh
    • 1
  • George J. Chang
    • 1
  • Stephen P. Hetz
    • 2
  • Jason B. Fleming
    • 1
  • Jeffrey E. Lee
    • 1
  • Matthew H. Katz
    • 1
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.William Beaumont Army Medical CenterEl PasoUSA

Personalised recommendations