Purpose: Pancreatic cancer is the fourth leading cause of cancer related mortality in the U.S. More than half of all pancreatic cancers are stage IV at diagnosis, where the use of systemic chemotherapy improves the median overall survival and quality of life. The pattern of systemic therapy use in stage IV pancreatic cancer, the patient characteristics, and health system factors that determine its use are unknown.
Results: Only 55% of stage 4 pancreatic cancer patients at VA Nebraska-Western Iowa Health Care System received systemic therapy. However, there was no significant difference in terms of age, gender, race, ethnicity, Charlson comorbidity score, distance travelled, socioeconomic status, and insurance type (P > .01 across all comparisons). Across all the hospitals reported by NCDB nationwide, the use of systemic therapy was significantly lower in female, nonwhite, patients aged > 40 years; those without insurance or with Medicare, Medicaid, and governmental insurance; higher Charlson comorbidity score; poor socioeconomic status; and those who received care in nonacademic centers.
Conclusions: This is the largest study to evaluate the determinants of systemic therapy use in stage IV pancreatic cancer. The use of systemic therapy in stage IV pancreatic cancer in the U.S. was significantly lower in female, African American/Hispanic patients, patients aged > 40 years, and those with higher Charlson comorbidity score. In addition, economic and educational status, as well as hospital and insurance types can affect the use of systemic therapy. These disparities in cancer care were not apparent in VA Nebraska-Western Iowa Health Care System. Understanding the barriers in the use of systemic therapy can help improve its utilization.
