How to Address Racial and Social Disparities in Pancreatic Cancer Care?

It is important to recognize disparities in pancreatic cancer, especially those concerning barriers to treatment access, inequal outcomes across racial and ethnic groups, and other social drivers of health, according to Jose G. Trevino, II, MD, FACS.

In a conversation with CancerNetwork®, Trevino discussed strategies for addressing some of the most prominent gaps and inequalities in pancreatic cancer care. For example, he highlighted relatively limited treatment access for those residing in rural areas as well as worse survival outcomes for patients who are Black. Additionally, he noted how one’s genetic background or ancestry may hold clues for better understanding the biology of pancreatic disease across different populations, which may, in turn, help improve treatment across the board.

Trevino is chair of the Division of Surgical Oncology and an associate professor in the Department of Surgery at VCU School of Medicine as well as surgeon-in-chief and Walter Lawrence, Jr., Distinguished Professor of Oncology at VCU Massey Cancer Center.

Transcript:

When you talk about health disparities, a lot of people think about race and ethnicity. I would venture to say, yes, there is a component to that. There are also a lot of other disparities as well. We’re talking social disparities or about people who don’t have access to care, and that could be anywhere in the rural areas of this country. If you look at West Virginia, to be honest, that is an incredibly rural state to some degree outside of some of its major cities. A lot of patients don’t have full access to the great components of West Virginia, like WVU (West Virginia University) and other areas. It’s disheartening because the disparities exist even there.

At the end of the day, pancreatic cancer doesn’t care whether you’re Black, White, Asian, or Latino. It doesn’t matter; what it does is it tries to kill. Disparities are important; we need to recognize them. Access to care is huge. The social drivers of health are huge. Are our patients being allowed the opportunity to get to these major comprehensive centers that will treat them best with the multidisciplinary team? That’s a disparity. Do they have full access to education on things they shouldn’t be doing (i.e. smoking tobacco or drinking)?

These things are also disparities in certain patient populations. When you look at the biology, there are certain aspects of the biologic behavior of pancreatic ductal adenocarcinoma that are clear. We know the patients who are Black, who are African American or Afro-Caribbean have a tendency to have a worse outcome with pancreatic ductal adenocarcinoma compared with [patients who are] White. There’s a paradox, to some degree, because Latino [patients] seem to do better than anybody. There are racial and ethnic disparities where Black [patients] do have worse outcomes, and there are also other socioeconomic disparities as well that we need to overcome to provide equitable outcomes.

That’s the goal for us: to be able to, No. 1, understand that. Not to complicate things further, but there might be...something real about who we are as a person, and maybe even as a race and ethnic group. For example, if you dig deep into our genetic background and our ancestry—where we come from—there might be clues. I tell people that we do research on everyone in terms of looking at certain things that might help us understand the disease better, and that’s what I mean by research. Can you imagine if, one day, we realize that there’s a particular gene that’s upregulated in a certain racial/ethnic group that might give us clues to how we might be able to combat the disease for everyone? That’s the goal; that is the absolute goal.