Pancreatic Cancer Survival: Disparities and Trends
Complex demographic and geographic disparities are influencing pancreatic cancer outcomes across the US, pointing to needs for broad public health interventions, targeted prevention strategies, and improved resource allocation to combat the shifting patient survival landscape of this malignancy. A trio of abstracts presented at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium exhibit mortality outcomes from this sixth-leading cause of cancer-related mortality worldwide,1 through patient outcomes information from a high-volume treatment area and mortality hotspots in the South and Midwest regions.1-3
These data from the CDC, the University of Texas MD Anderson Cancer Center, and the Institute for Health Metrics and Evaluation cover 1990 to 2024 and examine the pancreatic cancer burden across the intersections of rural and urban populations, races and ethnicities, and age and sex.
Pancreatic Cancer in Rural Areas1
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Incorporating data from CDC WONDER (Wide-ranging ONline Data for Epidemiologic Research) on deaths of adults 25 years and older (N = 1,002,439), researchers focused on age-adjusted mortality rates (AAMRs) per 100,000 population for 1999 to 2023 for urban (n = 698,805) and rural (n = 148,558) areas; remaining deaths were in another area. the AAMR was 17.66 (95% CI, 17.25-18.45) and it underwent a 0.33% average annual percent change (AAPC).
Although the AAMRs are close to equal when stratifying by rural (17.69; 95% CI, 17.03-18.96) vs urban (17.62; 95% CI, 17.30-18.02) location the AAPCs are separated by an immense gap: 0.77% vs 0.20%, with the mortality rate in
Pembrolizumab Shows Racial Disparities in Efficacy and Enrollment
A clinical trial of pembrolizumab demonstrated meaningful differences in overall survival (OS) and trial enrollment rates based on race, with Asian patients experiencing the highest benefit and Black and Hispanic patients facing lower enrollment and shorter survival times. These findings highlight ongoing disparities in cancer treatment outcomes and access to clinical trials.
Pembrolizumab and Overall Survival
Pembrolizumab, an immunotherapy drug, showed varying degrees of effectiveness in extending overall survival depending on a patient’s race. The trial data revealed a statistically significant difference in delivery rates (P < .001) across racial groups. Specifically,Asian patients exhibited the highest delivery rate at 92%,compared to 83% in Black patients.
Median overall survival differed substantially: 26.6 months for Asian patients, 20.7 months for non-Hispanic White (NHW) patients,18.6 months for Hispanic patients, and 17.4 months for Black patients. This suggests a potential biological or socioeconomic factor influencing treatment response.
Example: The median follow-up period for all patients in the trial was 3 months,providing a consistent timeframe for assessing survival outcomes across racial groups.
Racial Disparities in Trial Enrollment
Enrollment rates in the pembrolizumab trial also varied significantly by race, indicating potential barriers to access and participation for minority groups. Black patients comprised only 25% of the enrolled population (P < .001), while Hispanic patients represented 30% (P = .043), compared to 38% for non-Hispanic White patients.
These lower enrollment rates could be attributed to a variety of factors, including geographic limitations, lack of awareness about clinical trials, distrust of the medical system, and socioeconomic barriers. Lower enrollment can limit the generalizability of trial results to diverse populations.
Evidence: The statistically significant differences in enrollment (P < .001 for Black patients, P = .043 for Hispanic patients) demonstrate a clear disparity in access to this possibly life-extending treatment.
Implications and Future Research
The observed racial disparities in both treatment delivery and trial enrollment underscore the need for targeted interventions to improve equity in cancer care. Further research is needed to understand the underlying mechanisms driving these differences and to develop strategies to overcome barriers to access for underrepresented populations.
Addressing these disparities is crucial to ensuring that all patients, regardless of race or ethnicity, have the chance to benefit from advances in cancer treatment.