Disparities in access to surgical resection in patients with pancreatic cancer – a systematic review

Abstract

Background

Surgical resection is a crucial component of pancreatic cancer treatment. However, multiple disparities in access to surgical resection have been reported. This systematic review aimed to critically assess and summarize these disparities to improve equity in cancer care.

Methods

PubMed, Web of Science, Embase, Medline, and Cochrane databases were searched from 2000 to 2023. Primary research articles from the United States specifically evaluating surgical resection for resectable pancreatic adenocarcinoma cancer were included. Bias assessment was performed using the modified Newcastle-Ottawa Scale.

Results

A total of 19 studies met the final inclusion criteria. 16 studies reported disparities among minority groups, with Black and Hispanic patients less likely to undergo surgery. 15 studies reported older age being predictive of nonreceipt of surgery. Lower socioeconomic status, reported in 8 studies, and nonprivate insurance, reported in 7 studies, were determined to be independent risk factors for decreased receipt of surgery. Five studies reported that patients treated at community hospitals were less likely to receive surgery, and 4 studies identified being single as an independent risk factor for nonreceipt of surgery. Finally, residence in a rural location, reported in 1 study, and male sex, reported in 1 study, were determined to be predictive of decreased receipt of surgery.

Discussion

Various sociodemographic factors influence the access to surgical resection for pancreatic cancer. These factors are proxies for multiple underlying barriers along the continuum of care, some of which may be modifiable. Identifying and understanding these barriers will allow us to develop targeted interventions to improve the delivery of oncologic care.