Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2019; 11(2): 133-144
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.133
Age, socioeconomic features, and clinical factors predict receipt of endoscopic retrograde cholangiopancreatography in pancreatic cancer
Sheila D Rustgi, Sunil P Amin, Michelle K Kim, Satish Nagula, Nikhil A Kumta, Christopher J DiMaio, Paolo Boffetta, Aimee L Lucas
Sheila D Rustgi, Michelle K Kim, Satish Nagula, Nikhil A Kumta, Christopher J DiMaio, Aimee L Lucas, Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Sunil P Amin, Division of Gastroenterology, Virginia Mason Medical Center, Seattle, WA 98101, United States
Paolo Boffetta, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: Rustgi SD, Amin SP and Lucas AL contributed to study conception and design; Rustgi SD, Amin SP and Lucas AL contributed to data acquisition, data analysis and interpretation, and writing of article; Rustgi SD, Amin SP, Kim MK, Nagula S, Kumta NA, DiMaio CJ, Boffetta P and Lucas AL contributed to editing, reviewing and final approval of article.
Supported by American Cancer Society Grant, No. 129387-MRSG-16-015-01-CPHPS (to Lucas AL).
Institutional review board statement: This study was approved by the Mount Sinai Hospital Institutional Review Board and the National Cancer Institute.
Conflict-of-interest statement: None.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Aimee L Lucas, MD, MSc, Associate Professor, Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY 10029, United States. aimee.lucas@mssm.edu
Telephone: +1-212-2410101 Fax: +1-646- 5378647
Received: January 14, 2019
Peer-review started: January 14, 2019
First decision: January 21, 2019
Revised: February 1, 2019
Accepted: February 13, 2019
Article in press: February 13, 2019
Published online: February 16, 2019
Abstract
BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended technique for biliary decompression in pancreatic cancer. Previous studies have suggested racial, socioeconomic and geographic differences in diagnosis, treatment and outcomes of pancreatic cancer patients.

AIM

To examine geographic, racial, socioeconomic and clinical factors associated with utilization of ERCP.

METHODS

Surveillance, Epidemiology and End Results and linked Medicare claims data were used to identify pancreatic cancer patients between 2000-2011. Claims data were used to identify patients who had ERCP and other treatments. The primary outcome was receipt of ERCP. Chi-squared analyses were used to compare demographic information. Trends in use of ERCP over time were assessed using Cochran Armitage test. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for receipt ERCP were calculated using logistic regression, controlling for other characteristics.

RESULTS

Among 32510 pancreatic cancer patients, 14704 (45.2%) underwent ERCP. Patients who had cancer located in the head of the pancreas (aOR 3.27, 95%CI: 2.99-3.57), had jaundice (aOR 7.59, 95%CI: 7.06-8.17), cholangitis (aOR 4.22, 95%CI: 3.71-4.81) or pruritus (aOR 1.42, 95%CI: 1.22-1.66) and lived in lower education zip codes (aOR 1.14, 95%CI: 1.04-1.24) were more likely to receive ERCP. In contrast, patients who were older (aOR 0.88, 95%CI: 0.83, 0.94), not married (aOR 0.92, 95%CI: 0.86, 0.98), and lived in a non-metropolitan area (aOR 0.89, 95%CI: 0.82, 0.98) were less likely to receive ERCP. Compared to white patients, non-white/non-black patients (aOR 0.83, 95%CI: 0.70-0.97) were less likely to receive ERCP. Patients diagnosed later in the study period were less likely to receive ERCP (aOR 2004-2007 0.85, 95%CI: 0.78-0.92; aOR 2008-2011 0.76, 95%CI: 0.70-0.83). After stratifying by indications for ERCP including jaundice, racial differences persisted (aOR black patients 0.80, 95%CI: 0.67-0.95, nonwhite/nonblack patients 0.73, 95%CI: 0.58-0.91). Among patients with jaundice, those who underwent surgery were less likely to undergo ERCP (aOR 0.60, 95%CI: 0.52, 0.69).

CONCLUSION

ERCP utilization in pancreatic cancer varies based on patient age, marital status, and factors related to where the patient lives. Further studies are needed to guide appropriate biliary intervention for these patients.

Keywords: Pancreatic cancer, Endoscopic retrograde cholangiopancreatography, Socioeconomic disparities, Racial disparities, Jaundice, Outcomes research

Core tip: The use of endoscopic retrograde cholangiopancreatography for pancreatic cancer patients varies nationally by non-clinical factors. Further studies and guidelines are needed to guide appropriate biliary interventions for these patients.