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, 8 (6), 3314-3324

Racial and Ethnic Disparities in a State-Wide Registry of Patients With Pancreatic Cancer and an Exploratory Investigation of Cancer Cachexia as a Contributor to Observed Inequities

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Racial and Ethnic Disparities in a State-Wide Registry of Patients With Pancreatic Cancer and an Exploratory Investigation of Cancer Cachexia as a Contributor to Observed Inequities

Jennifer B Permuth et al. Cancer Med.

Abstract

Pancreatic cancer (PC) is characterized by racial/ethnic disparities and the debilitating muscle-wasting condition, cancer cachexia. Florida ranks second in the number of PC deaths and has a large and understudied minority population. We examined the primary hypothesis that PC incidence and mortality rates may be highest among Black Floridians and the secondary hypothesis that biological correlates of cancer cachexia may underlie disparities. PC incidence and mortality rates were estimated by race/ethnicity, gender, and county using publicly available state-wide cancer registry data that included approximately 2700 Black, 25 200 Non-Hispanic White (NHW), and 3300 Hispanic/Latino (H/L) Floridians diagnosed between 2004 and 2014. Blacks within Florida experienced a significantly (P < 0.05) higher incidence (12.5/100 000) and mortality (10.97/100 000) compared to NHW (incidence = 11.2/100 000; mortality = 10.3/100 000) and H/L (incidence = 9.6/100 000; mortality = 8.7/100 000), especially in rural counties. To investigate radiologic and blood-based correlates of cachexia, we leveraged data from a subset of patients evaluated at two geographically distinct Florida Cancer Centers. In Blacks compared to NHW matched on stage, markers of PC-induced cachexia were more frequent and included greater decreases in core musculature compared to corresponding healthy control patients (25.0% vs 10.1% lower), greater decreases in psoas musculature over time (10.5% vs 4.8% loss), lower baseline serum albumin levels (3.8 vs 4.0 gm/dL), and higher platelet counts (332.8 vs 268.7 k/UL). Together, these findings suggest for the first time that PC and cachexia may affect Blacks disproportionately. Given its nearly universal contribution to illness and PC-related deaths, the early diagnosis and treatment of cachexia may represent an avenue to improve health equity, quality of life, and survival.

Keywords: biomarkers; cachexia; incidence; mortality; pancreatic cancer; racial disparities.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Map of Pancreatic Cancer Incidence and Death Rates by Race/Ethnicity and Florida County. This map displays mean age‐adjusted A. incidence and B. death rates of pancreatic cancer for the years 2004‐2014 (pop std: 2000 US Standard) by Florida county for White, Black, and H/L Floridians (as reported by the Florida Department of Health, Bureau of Vital Statistics). Race/ethnicity groups are distinguished using red (White), blue (Black), or gold (H/L) dots of graduated sizes. Larger dots indicate higher average incidence or death rates. The peninsula is divided into seven geographic regions that were determined by Rosemurgy et al18 using the cost of living index and the urban to rural population ratio. H/L, Hispanic/Latino
Figure 2
Figure 2
A, Psoas musculature (arrows) is observed for a representative NHW PC patient with long‐term survival (left) and a Black patient succumbing to disease within 2 mo of resection (right). B and C, In a cohort of 93 advanced PC patients, Black patients presented with significantly reduced serum albumin levels (left panel B), which corresponded to poorer survival in Black (solid line) versus NHW patients (dashed line) (right panel C). NHW, Non‐Hispanic White; PC, pancreatic cancer
Figure 3
Figure 3
Axial CT images for a Black (top panel) and NHW PC patient (bottom panel). A, Baseline/preoperative image at the inferior endplate of L3 vertebral body. B, Axial image after skeletal muscle is segmented (in green) and non‐muscular structures are excluded using a HU threshold of −29‐+150. C and D, six and 12 mo postoperative follow‐up CT exams showed downward trends in SMI and PMI, especially for the Black patient. Psoas muscle area is outlined in blue on images. Skeletal muscle and psoas muscle areas were calculated on each exam and indexed for patient's height. Note: The NHW patient has higher baseline SMI but lower PMI than the Black patient which can be explained by the relative smaller size of psoas muscles with respect to other skeletal muscles. CT, computed tomography; HU, hounsfield unit; NHW, Non‐Hispanic White; PC, pancreatic cancer; PMI, psoas muscle index; SMI, skeletal muscle index

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