PDF(Pubmed)
Abstract：
BACKGROUND: Pancreatic cancer remains one of the deadliest cancers in the United States. Some types of pancreatic cysts, which are being detected more frequently and often incidentally on imaging, have the potential to develop into pancreatic cancer and thus provide a valuable window of opportunity for cancer interception. Although racial disparity in pancreatic cancer has been described, little is known regarding health disparities in pancreatic cancer prevention. In the present study, we investigate potential health disparities along the continuum of care for pancreatic cancer.
METHODS: The racial and ethnic composition of pancreatic patients at high-volume centers in Indiana were evaluated, representing patients undergoing surgery for pancreatic cancer (n=390), participating in biobanking (972 pancreatic cancer patients and 1984 patients with pancreatic disease), or being monitored for pancreatic cysts at an early detection center (n=1514). To assess racial disparities and potential differences in decision-making related to pancreatic cancer prevention and early detection, an exploratory online survey was administered through a volunteer registry (n=708). Results: We show that despite comprising close to 10% or 30% of the Indiana or Indianapolis population, respectively, African Americans make up only about 4-5% of our study cohorts consisting of patients undergoing pancreatic surgery or participating in biobanking and early detection. Analysis of online survey results revealed that given the hypothetical situation of being diagnosed with a pancreatic cyst or pancreatic cancer, the vast majority of respondents (>90%) would agree to undergo surveillance or surgery, respectively, regardless of race. Only a minority (3-12%) acknowledged any significant transportation, financial, or emotional barriers that would impact a decision to undergo surveillance or surgery. This suggests that the observed racial disparities may be due in part to the existence of other barriers that lie upstream of this decision point.
CONCLUSIONS: Racial disparities exist not only for pancreatic cancer but also at earlier points along the continuum of care such as prevention and early detection. To our knowledge, this is the first study to document racial disparity in the management of patients with pancreatic cysts who are at risk of developing pancreatic cancer. Our results suggest that improving access to information and care for such at-risk individuals may lead to more equitable outcomes.
METHODS: The racial and ethnic composition of pancreatic patients at high-volume centers in Indiana were evaluated, representing patients undergoing surgery for pancreatic cancer (n=390), participating in biobanking (972 pancreatic cancer patients and 1984 patients with pancreatic disease), or being monitored for pancreatic cysts at an early detection center (n=1514). To assess racial disparities and potential differences in decision-making related to pancreatic cancer prevention and early detection, an exploratory online survey was administered through a volunteer registry (n=708). Results: We show that despite comprising close to 10% or 30% of the Indiana or Indianapolis population, respectively, African Americans make up only about 4-5% of our study cohorts consisting of patients undergoing pancreatic surgery or participating in biobanking and early detection. Analysis of online survey results revealed that given the hypothetical situation of being diagnosed with a pancreatic cyst or pancreatic cancer, the vast majority of respondents (>90%) would agree to undergo surveillance or surgery, respectively, regardless of race. Only a minority (3-12%) acknowledged any significant transportation, financial, or emotional barriers that would impact a decision to undergo surveillance or surgery. This suggests that the observed racial disparities may be due in part to the existence of other barriers that lie upstream of this decision point.
CONCLUSIONS: Racial disparities exist not only for pancreatic cancer but also at earlier points along the continuum of care such as prevention and early detection. To our knowledge, this is the first study to document racial disparity in the management of patients with pancreatic cysts who are at risk of developing pancreatic cancer. Our results suggest that improving access to information and care for such at-risk individuals may lead to more equitable outcomes.
摘要：
背景：胰腺癌仍然是美国最致命的癌症之一。某些类型的胰腺囊肿,它们在成像时被更频繁地检测到，有可能发展为胰腺癌，从而为癌症拦截提供了宝贵的机会。尽管已经描述了胰腺癌的种族差异，人们对胰腺癌预防中的健康差异知之甚少。在本研究中,我们调查了胰腺癌治疗连续过程中潜在的健康差异.
方法：评估了印第安纳州高容量中心胰腺患者的种族和民族构成，代表接受胰腺癌手术的患者（n=390），参与生物基线（972例胰腺癌患者和1984例胰腺疾病患者），或在早期检测中心监测胰腺囊肿（n=1514）。评估与胰腺癌预防和早期发现相关的种族差异和决策的潜在差异。我们通过志愿者注册中心进行了一项探索性在线调查(n=708).结果：我们表明，尽管占印第安纳州或印第安纳波利斯人口的近10％或30％，分别,非洲裔美国人仅占我们研究队列的4-5％，这些研究队列包括接受胰腺手术或参与生物分析和早期检测的患者。对在线调查结果的分析显示，鉴于被诊断为胰腺囊肿或胰腺癌的假设情况，绝大多数受访者（>90％）会同意接受监视或手术，分别,不管种族。只有少数人（3-12％）承认任何重要的运输，金融,或情感障碍会影响进行监视或手术的决定。这表明观察到的种族差异可能部分是由于该决策点上游存在其他障碍。
结论：种族差异不仅存在于胰腺癌中，而且存在于持续治疗的早期阶段，如预防和早期发现。据我们所知,这是第一项记录有胰腺癌风险的胰腺囊肿患者治疗中种族差异的研究.我们的结果表明，改善对此类高危人群的信息获取和护理可能会带来更公平的结果。
方法：评估了印第安纳州高容量中心胰腺患者的种族和民族构成，代表接受胰腺癌手术的患者（n=390），参与生物基线（972例胰腺癌患者和1984例胰腺疾病患者），或在早期检测中心监测胰腺囊肿（n=1514）。评估与胰腺癌预防和早期发现相关的种族差异和决策的潜在差异。我们通过志愿者注册中心进行了一项探索性在线调查(n=708).结果：我们表明，尽管占印第安纳州或印第安纳波利斯人口的近10％或30％，分别,非洲裔美国人仅占我们研究队列的4-5％，这些研究队列包括接受胰腺手术或参与生物分析和早期检测的患者。对在线调查结果的分析显示，鉴于被诊断为胰腺囊肿或胰腺癌的假设情况，绝大多数受访者（>90％）会同意接受监视或手术，分别,不管种族。只有少数人（3-12％）承认任何重要的运输，金融,或情感障碍会影响进行监视或手术的决定。这表明观察到的种族差异可能部分是由于该决策点上游存在其他障碍。
结论：种族差异不仅存在于胰腺癌中，而且存在于持续治疗的早期阶段，如预防和早期发现。据我们所知,这是第一项记录有胰腺癌风险的胰腺囊肿患者治疗中种族差异的研究.我们的结果表明，改善对此类高危人群的信息获取和护理可能会带来更公平的结果。
