Regional and racial variations in the utilization of endoscopic retrograde cholangiopancreatography among pancreatic cancer patients in the United States

Anna Tavakkoli, Amit Singal, Akbar K. Waljee, James M. Scheiman, Caitlin Claffey Murphy, Sandi Pruitt, Lei Xuan, Richard S. Kwon, Ryan J. Law, Grace H. Elta, Phyllis Wright-Slaughter, Thomas S. Valley, Nisa Kubiliun, Hari Nathan, Joel H. Rubenstein, B. Joseph Elmunzer

Research output: Contribution to journalArticle

Abstract

Background: Pancreatic cancer is projected to become the second leading cause of cancer-related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as first-line therapy for biliary decompression in pancreatic cancer. The aim of our study was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer. Methods: Retrospective cohort study using the US Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients diagnosed with pancreatic cancer from 2003-2013. The primary outcome was receipt of ERCP, with or without stent placement, vs any non-ERCP biliary intervention. Results: Of the 36 619 patients with pancreatic cancer, 37.5% (n = 13 719) underwent an ERCP, percutaneous drainage, or surgical biliary bypass. The most common biliary intervention (82.6%) was ERCP. After adjusting for tumor location and stage, Blacks were significantly less likely to receive ERCP than Whites (aOR 0.84, 95% CI 0.72, 0.97) and more likely to receive percutaneous transhepatic biliary drainage (PTBD) (aOR 1.38, 95% CI 1.14, 1.66). Patients in the Southeast and the West were more likely to receive ERCP than those in the Northeast (Southeast aOR 1.21, 95% CI 1.04, 1.40; West aOR 1.16, 95% CI 1.01, 1.32). Conclusion: Racial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients.

Original languageEnglish (US)
Pages (from-to)3420-3427
Number of pages8
JournalCancer Medicine
Volume8
Issue number7
DOIs
StatePublished - Jul 1 2019

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Endoscopic Retrograde Cholangiopancreatography
Pancreatic Neoplasms
Drainage
Medicare
Decompression
Stents
Neoplasms
Epidemiology
Cohort Studies
Retrospective Studies
Databases
Research

Keywords

  • disparities
  • ERCP
  • obstructive jaundice
  • pancreatic cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Regional and racial variations in the utilization of endoscopic retrograde cholangiopancreatography among pancreatic cancer patients in the United States. / Tavakkoli, Anna; Singal, Amit; Waljee, Akbar K.; Scheiman, James M.; Murphy, Caitlin Claffey; Pruitt, Sandi; Xuan, Lei; Kwon, Richard S.; Law, Ryan J.; Elta, Grace H.; Wright-Slaughter, Phyllis; Valley, Thomas S.; Kubiliun, Nisa; Nathan, Hari; Rubenstein, Joel H.; Elmunzer, B. Joseph.

In: Cancer Medicine, Vol. 8, No. 7, 01.07.2019, p. 3420-3427.

Research output: Contribution to journalArticle

Tavakkoli, A, Singal, A, Waljee, AK, Scheiman, JM, Murphy, CC, Pruitt, S, Xuan, L, Kwon, RS, Law, RJ, Elta, GH, Wright-Slaughter, P, Valley, TS, Kubiliun, N, Nathan, H, Rubenstein, JH & Elmunzer, BJ 2019, 'Regional and racial variations in the utilization of endoscopic retrograde cholangiopancreatography among pancreatic cancer patients in the United States', Cancer Medicine, vol. 8, no. 7, pp. 3420-3427. https://doi.org/10.1002/cam4.2225
Tavakkoli, Anna ; Singal, Amit ; Waljee, Akbar K. ; Scheiman, James M. ; Murphy, Caitlin Claffey ; Pruitt, Sandi ; Xuan, Lei ; Kwon, Richard S. ; Law, Ryan J. ; Elta, Grace H. ; Wright-Slaughter, Phyllis ; Valley, Thomas S. ; Kubiliun, Nisa ; Nathan, Hari ; Rubenstein, Joel H. ; Elmunzer, B. Joseph. / Regional and racial variations in the utilization of endoscopic retrograde cholangiopancreatography among pancreatic cancer patients in the United States. In: Cancer Medicine. 2019 ; Vol. 8, No. 7. pp. 3420-3427.
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abstract = "Background: Pancreatic cancer is projected to become the second leading cause of cancer-related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as first-line therapy for biliary decompression in pancreatic cancer. The aim of our study was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer. Methods: Retrospective cohort study using the US Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients diagnosed with pancreatic cancer from 2003-2013. The primary outcome was receipt of ERCP, with or without stent placement, vs any non-ERCP biliary intervention. Results: Of the 36 619 patients with pancreatic cancer, 37.5{\%} (n = 13 719) underwent an ERCP, percutaneous drainage, or surgical biliary bypass. The most common biliary intervention (82.6{\%}) was ERCP. After adjusting for tumor location and stage, Blacks were significantly less likely to receive ERCP than Whites (aOR 0.84, 95{\%} CI 0.72, 0.97) and more likely to receive percutaneous transhepatic biliary drainage (PTBD) (aOR 1.38, 95{\%} CI 1.14, 1.66). Patients in the Southeast and the West were more likely to receive ERCP than those in the Northeast (Southeast aOR 1.21, 95{\%} CI 1.04, 1.40; West aOR 1.16, 95{\%} CI 1.01, 1.32). Conclusion: Racial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients.",
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AU - Tavakkoli, Anna

AU - Singal, Amit

AU - Waljee, Akbar K.

AU - Scheiman, James M.

AU - Murphy, Caitlin Claffey

AU - Pruitt, Sandi

AU - Xuan, Lei

AU - Kwon, Richard S.

AU - Law, Ryan J.

AU - Elta, Grace H.

AU - Wright-Slaughter, Phyllis

AU - Valley, Thomas S.

AU - Kubiliun, Nisa

AU - Nathan, Hari

AU - Rubenstein, Joel H.

AU - Elmunzer, B. Joseph

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N2 - Background: Pancreatic cancer is projected to become the second leading cause of cancer-related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as first-line therapy for biliary decompression in pancreatic cancer. The aim of our study was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer. Methods: Retrospective cohort study using the US Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients diagnosed with pancreatic cancer from 2003-2013. The primary outcome was receipt of ERCP, with or without stent placement, vs any non-ERCP biliary intervention. Results: Of the 36 619 patients with pancreatic cancer, 37.5% (n = 13 719) underwent an ERCP, percutaneous drainage, or surgical biliary bypass. The most common biliary intervention (82.6%) was ERCP. After adjusting for tumor location and stage, Blacks were significantly less likely to receive ERCP than Whites (aOR 0.84, 95% CI 0.72, 0.97) and more likely to receive percutaneous transhepatic biliary drainage (PTBD) (aOR 1.38, 95% CI 1.14, 1.66). Patients in the Southeast and the West were more likely to receive ERCP than those in the Northeast (Southeast aOR 1.21, 95% CI 1.04, 1.40; West aOR 1.16, 95% CI 1.01, 1.32). Conclusion: Racial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients.

AB - Background: Pancreatic cancer is projected to become the second leading cause of cancer-related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as first-line therapy for biliary decompression in pancreatic cancer. The aim of our study was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer. Methods: Retrospective cohort study using the US Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients diagnosed with pancreatic cancer from 2003-2013. The primary outcome was receipt of ERCP, with or without stent placement, vs any non-ERCP biliary intervention. Results: Of the 36 619 patients with pancreatic cancer, 37.5% (n = 13 719) underwent an ERCP, percutaneous drainage, or surgical biliary bypass. The most common biliary intervention (82.6%) was ERCP. After adjusting for tumor location and stage, Blacks were significantly less likely to receive ERCP than Whites (aOR 0.84, 95% CI 0.72, 0.97) and more likely to receive percutaneous transhepatic biliary drainage (PTBD) (aOR 1.38, 95% CI 1.14, 1.66). Patients in the Southeast and the West were more likely to receive ERCP than those in the Northeast (Southeast aOR 1.21, 95% CI 1.04, 1.40; West aOR 1.16, 95% CI 1.01, 1.32). Conclusion: Racial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients.

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