NCCN Data Find Racial, Socioeconomic Disparities in Quality of Care for Metastatic Pancreatic Cancer

Significant disparities in the quality of care and outcomes for patients diagnosed with metastatic pancreatic ductal adenocarcinoma (mPDAC) were revealed in a study published today in the Journal of the National Comprehensive Cancer Network.¹ Race and socioeconomic status were identified, among other factors, as key contributors to care quality received by patients living with this deadly form of cancer.

Socially vulnerable and minority patients with metastatic pancreatic cancer are less likely to receive recommended treatments and achieve longer survival.

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"The results of our study highlight the need for targeted interventions to mitigate disparities in cancer care," lead author Diamantis Tsilimigras, MD, PhD, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, said in a statement.²

The study assessed data from 14,147 Medicare beneficiaries diagnosed with mPDAC between 2005 and 2019; researchers analyzed treatment trends and survival outcomes using a novel quality metric.¹ This metric evaluated whether patients received guideline-concordant systemic therapy, palliative care, or hospice services, and survived at least 12 months after diagnosis.

While overall achievement of at least 1 of these quality indicators increased substantially over time from 84.5% in 2005 to 97.0% in 2019 (P < .001), prominent gaps were observed for patients from socially vulnerable and minority backgrounds.

"Although the proportion of all individuals achieving these criteria increased over time, socially vulnerable populations mainly relative to socioeconomic and racial/ethnic minority status had lower likelihood of achieving at least one of the quality score criteria," the study authors wrote. "Despite the overall poor prognosis of mPDAC, meeting at least one quality score criterion was associated with improved CSS [cancer-specific survival], which was mainly driven by the receipt of systemic chemotherapy."

Only 13.7% of patients achieved cancer-specific survival beyond 12 months. Nearly two-thirds (62.2%) received systemic therapy, and 83.3% utilized palliative or hospice care. However, multivariable analysis showed that patients from areas with higher social vulnerability were significantly less likely to meet any of the quality criteria. This was especially true for those living in communities with high socioeconomic disadvantage or a high proportion of racial and ethnic minorities.

Specifically, a high overall Social Vulnerability Index (SVI) was linked to a 30% lower likelihood of meeting any of the quality measures (OR, 0.70; 95% CI, 0.54–0.91), with this disparity largely driven by socioeconomic factors (OR, 0.66; 95% CI, 0.48–0.90) and communities with a high proportion of racial and ethnic minorities (OR, 0.75; 95% CI, 0.60–0.93). Additionally, achieving at least 1 quality indicator (excluding survival) was associated with markedly improved outcomes, with 1-year cancer-specific survival rates of 14.5% compared with just 3.2% in those who received neither systemic therapy nor palliative care (P < .001).

Patients who met at least 1 of the quality criteria were more likely to be White (79.4% vs 70.2%), live in areas with low social vulnerability (32.1% vs 22.5%), and reside in communities with the highest median household incomes (top quartile: 24.1% vs 19.2%) compared with those who met none of the criteria (P < .001). Multivariable analysis confirmed that high SVI was independently associated with lower odds of receiving both palliative or hospice services (28%; OR, 0.72), systemic therapy (12%; OR, 0.88), and overall lower odds of achieving a quality score of at least 1 (30%; OR, 0.70). Conversely, patients living in areas with higher household incomes had significantly greater odds of receiving systemic chemotherapy (top quartile: OR, 1.51), surviving more than 1 year post diagnosis (OR, 1.61), and achieving a quality score of at least 1 (third quartile: OR, 1.39).

"Federal policies that expand Medicaid or possibly expand Medicare coverage for palliative care can help reduce disparities," Tsilimigras stated.² "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."

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 9, 2025. https://www.prnewswire.com/news-releases/new-research-in-jnccn-finds-stark-disparities-in-treatment-and-survival-time-for-people-with-pancreatic-cancer-302424571.html