Treatment at an Academic Medical Center Eliminates Survival Disparities for Appalachian Kentuckians with Pancreatic Ductal Adenocarcinoma

Authors

Emily Cassim, University of KentuckyFollow
Hannah McDonald, The University of KentuckyFollow
Megan Harper, University of KentuckyFollow
Quan Chen, University of KentuckyFollow
Miranda Lin, University of KentuckyFollow
Reema Patel, University of KentuckyFollow
Michael Cavnar, University of KentuckyFollow
Prakash Pandalai, University of KentuckyFollow
Bin Huang, University of KentuckyFollow
Pamela C. Hull, University of KentuckyFollow
Joseph Kim, University of KentuckyFollow
Erin Burke, University of KentuckyFollow

Corresponding Author

Hannah McDonald, MD

Author Affiliations

Hannah McDonald^1,4, MD, Emily Cassim^1,4, MD; Anna Reagan¹, MD; Megan Harper¹, MS, MD, PhD; Quan Chen², DrPH; Miranda Lin¹, MD; Reema Patel³ MD; Michael Cavnar¹, MD; Prakash Pandalai¹, MD; Mautin Barry-Hundeyin¹, MD; Feitong Lei², PhD; Bin Huang², DrPH; Pamela C. Hull², PhD; Erin E Burke¹, MD, MS; Joseph Kim¹, MD

1. Division of Surgical Oncology, University of Kentucky, Lexington, KY 40536
2. Markey Cancer Center, University of Kentucky, Lexington, KY, 40536
3. Division of Hematology and Oncology, University of Kentucky, Lexington, KY 40508
4. HM and EC are co-first authors

Author Area of Expertise

Emily Cassim - Medicine, Surgical Oncology

Hannah McDonald - Medicine, Surgery, Surgical Oncology, Clinical and Translational Research

Megan Harper - Medicine, Surgery, Surgical Oncology, Clinical and Translational Research

Quan Chen - Biostatistics

Miranda Lin - Medicine, Surgical Oncology

Reema Patel - medical oncology, clinical cancer research

Michael Cavnar - Surgical Oncology, hepatobiliary surgery

Prakash Pandalai - Surgical Oncology, HIPEC

Bin Huang - Biostatistics

Pamela Hull - medical sociologist

Joseph Kim - Surgical Oncology, Clinical and Translational Research

Erin Burke - Surgical Oncology, Breast Oncology, Clinical Research

Abstract

Introduction: Rates of cancer mortality in Appalachian Kentucky is among the highest in the nation. It is unknown whether geographic location of treatment for pancreatic ductal adenocarcinoma (PDAC), one of the deadliest cancers worldwide, influences survival in Appalachian Kentuckians.

Purpose: This study compares outcomes among Appalachian Kentuckians with PDAC who received treatment at an academic medical center (AMC) or community facility (CF).

Methods: Using the Kentucky Cancer Registry, patients diagnosed with PDAC between 2003 and 2018 were identified. Patients were categorized according to treatment location (AMC v. CF) and county of residence (Appalachian v. non-Appalachian). Kaplan-Meier curves were constructed to assess survival and multivariate Cox regression analyses were performed.

Results: Overall, out of 4,402 PDAC patients, 87.3% received treatment at CFs and 12.7% at an AMC. When stratified by treatment location and Appalachian status, significant differences were found in clinicopathologic factors, such as age, smoking, insurance status, stage, and treatment (p < .05). Factors significantly associated with decreased survival included treatment at a CF (HR 1.53 for Appalachian, 1.25 for Non-Appalachian), patient age > 75 years (HR 1.44), having Medicare/Medicaid insurance (HR 1.23/1.16), and history of smoking (HR 1.11). Decreased 1- and 5-year survival was associated with treatment at a CF for both Appalachian (27.4% and 3.6%) and Non-Appalachian (36% and 5.7%) patients (p < .001).

Implications: Improved survival of Kentuckians treated at an AMC suggests that poorer PDAC outcomes in Appalachian patients may be related to access to tertiary care. Future research should examine potential reasons for these disparate outcomes and strategies for increasing the quality of cancer care at CFs.

DOI

https://doi.org/10.13023/jah.0601.02

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

McDonald H, Cassim E, Reagan A, Harper M, Chen Q, Lin M, et al. Treatment at an academic medical center eliminates survival disparities for Appalachian Kentuckians with pancreatic ductal adenocarcinoma. J Appalach Health 2024;6(1):5–19. DOI: https://doi.org/10.13023/jah.0601.02