PURPOSE Patients racialized as Black experience a higher mortality from pancreatic cancer (PC). Worse survival outcomes may relate to differences in delivered treatment. This study examined differences in receipt of guideline-concordant care (GCC) among older adults with PC according to race and ethnicity. METHODS Patients 65 years and older with incident PC racialized as non-Hispanic White (NH-White) or racialized as NH-Black or of Hispanic ethnicity were identified in the SEER-Medicare database from 2004 to 2019. The primary outcome was receipt of stage-specific GCC. Multivariable logistic regression identified factors associated with GCC. Oaxaca-Blinder decomposition examined the contribution of measured and unmeasured variables to racial disparities in receipt of GCC. RESULTS Of 12,772 patients included, 85.5% of patients racialized as NH-White (n = 10,915), 7.8% of patients racialized as NH-Black (n = 992), and 6.8% of patients were of Hispanic ethnicity (n = 865). In total, 56.3% of patients received GCC. On adjusted analysis, patients racialized as NH-Black were less likely to receive GCC for stage I/II disease compared with patients racialized as NH-White (odds ratio OR, 0.66 95% CI, 0.53 to 0.83), but not for stage III (OR, 0.65 95% CI, 0.41 to 1.01) or stage IV (OR, 0.87 95% CI, 0.66 to 1.14). GCC did not differ between Hispanic patients and NH-White patients. On decomposition analysis, differences in GCC among NH-Black and NH-White patients remained largely unexplained, but dual eligibility, census tract–level poverty, and comorbidities were the measured factors that contributed most to the disparity in GCC. CONCLUSION Approximately half of an insured population with PC receives GCC, highlighting a need to improve multidisciplinary access and treatment. Black-White racial disparities in receipt of GCC remain prevalent, particularly for early-stage disease. The unmeasured factors driving treatment disparities warrant prospective studies.
Herb et al. (Wed,) studied this question.