Presentations

Abstract

Introduction:

Pancreatic Ductal Adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths, with only 12% of patients surviving 5 years post-diagnosis. The dismal prognosis of PDAC is attributed to the delayed onset of symptoms, lack of an early and effective screening method, unsuccessful treatment, and advanced and metastatic presentation, rendering a majority of PDAC patients ineligible for surgical resection. As surgery represents the only "curative" measure, current treatment regimens for inoperable presentations only provide palliative support rather than remedial intervention, forcing this population to confront an unfortunate prognosis. The median survival for inoperable PDAC is less than one year, and three years for operable PDAC. Further, black/African American (AA) patients suffer a 30-70% higher PDAC mortality rate than other racial groups in the United States. From 2015 to 2019, the black/AA PDAC population in Hampton Roads, Virginia experienced a 17.3% mortality rate, which is a striking difference compared to its white counterpart's mortality rate of 10.8%. Therefore, this project was developed after a disparate disease burden of PDAC was identified in the black/AA Hampton Roads community.

Methods:

Retrospective medical record review of 427 inoperable PDAC patients from the Sentara Cancer Network and Virginia Oncology Associates (VOA) was conducted. The age at diagnosis, treatment onset/delay, treatment type, survival time, and death date of the black/AA and white inoperable cohorts were extracted. Average length of disease, age at diagnosis, and time between diagnosis and treatment were calculated. Average administration of each therapy type for both populations was also generated. Chi-square and T-tests were run to generate p-values. KM survival analysis was also performed to compare the survival rates of the Black and white inoperable PDAC patients in Hampton Roads, Virginia.

Results:

From 2008 to 2016, the white PDAC cohort experienced a lower 1-5-year survival rate than the black/AA PDAC cohort. The black/AA population's average length of disease was 249 days, while it was only 190 days in the white population. The white cohort also had an older average age at diagnosis compared to the black/AA cohort's age at diagnosis, which was 67 and 70, respectively. The difference in the time between diagnosis and initiation of treatment was not statistically significant, however, 42.1% of white PDAC patients did not receive treatment, yet only 29.9% of black PDAC patients went without treatment. Further, 35% of the black population and 25.9% of the white population received both chemotherapy and radiation.

Discussion:

Despite the higher mortality rate present in the black/AA PDAC population in Hampton Roads, Virginia, the white inoperable PDAC cohort had a reduced length of disease and survival rate. A higher proportion of their population also did not receive any therapy compared to the black/AA inoperable PDAC population. This could be explained by the white population's older average age at diagnosis, as they were more likely to have additional comorbidities and advanced stages of disease. Further, as chemotherapy is unlikely to extend their life span, elder patients often opt out of treatment due to the drastic decrease in quality of life. Additionally, the prolonged disease survival observed in a subset of black/AA inoperable patients could paradoxically be attributed to a high mortality rate in black/AA patients. Inoperable PDAC patients typically die within a year, yet 21% of the black/AA cohort survived past a year, with 3.4% of patients living over 3 years. This prompts questions about why these patients were classified as inoperable, and if they should have been deemed operable and provided access to the only curative treatment available. Therefore, this discovery has inspired further examination into the clinical decisions that characterized these patients as inoperable. Investigation into other parameters, such as stage at diagnosis and standard of care adherence, will also be performed to continue our research in identifying the factors underlying the high mortality rate in the black/AA PDAC Hampton Roads population.