Racial and Socioeconomic Disparities in the Treatments and Outcomes of Pancreatic Cancer Among Different Treatment Facility Types.

OBJECTIVES: The aim of this study was to investigate racial and socioeconomic disparities for patients with pancreatic cancer across different facility types. METHODS: The National Cancer Database was queried for pancreatic cancer cases from 2004 to 2015. Along with propensity score matching analysis, multivariate logistic and Cox model were used to assess effects of facility type, race, elements of socioeconomics on receipt of treatment, time to treatment, and overall survival, separately. RESULTS: Among 223,465 patients, 44.6%, 42.1%, and 13.3% were treated at academic, community, and integrated facilities, respectively. Private insurance was associated with more treatment (odds ratio, 1.41; P < 0.001) and better survival [hazards ratio (HR), 0.84; P < 0.001]. Higher education was associated with earlier treatment (HR, 1.09; P < 0.001). African Americans had less treatment (odds ratio, 0.97; P = 0.04) and delayed treatment (HR, 0.89; P < 0.001) despite later stage at diagnosis. After adjusting for socioeconomic status, African Americans had similar survival (HR, 0.99; P = 0.11) overall and improved survival (HR, 0.95; P = 0.016) at integrated facilities. CONCLUSIONS: Higher socioeconomic status was associated with better treatment and survival. After adjusting for socioeconomic disparities, race did not affect survival. Less racial disparity was observed at integrated facilities.

Radical Prostatectomy Without Pelvic Lymph Node Dissection Is Widely Practiced in High-Risk Patients Despite Poorer Survival.

PURPOSE: Radical prostatectomy with pelvic lymph node dissection (PLND) is the standard of care for unfavorable risk prostate cancer. We investigated dissection practice patterns and their impact on overall survival using a large national database. PATIENTS AND METHODS: Men with prostate adenocarcinoma diagnosed between 2004 and 2013 were identified from the National Cancer Data Base. Disease was classified as either favorable or unfavorable on the basis of National Comprehensive Cancer Network guidelines. Minimum follow-up was 4 years. All patients received risk-appropriate surgery: prostatectomy with or without PLND. Prostatectomy alone and prostatectomy with PLND was propensity score matched within each risk cohort. Survival analysis included Kaplan-Meier statistics, Cox proportional hazards model, and multivariate logistic regression. RESULTS: A total of 66,469 subjects met the inclusion criteria. Median (range) age was 63 (27-90) years. Median (range) follow-up was 59.53 (48-143.54) months. Within the cohort of patients with favorable risk disease, 51% did not undergo nodal dissection. Matched analysis demonstrated no difference in survival (P = .926). Within the cohort of patients with unfavorable risk disease, 39.2% did not receive nodal dissection. Matched analysis demonstrated that nodal dissection had superior survival (log-rank P = .002; hazard ratio = 0.624; 95% confidence interval, 0.466-0.835; P = .002). Greater odds of receiving nodal dissection included an open or robot-assisted approach compared to a laparoscopic approach, academic/research programs, and higher risk groups. CONCLUSION: Although PLND is associated with a significant survival benefit in men with unfavorable risk prostate cancer, nearly 40% of patients with unfavorable risk disease did not receive PLND.

Acupuncture for the alleviation of hot flashes in men treated with androgen ablation therapy.

PURPOSE: Hot flashes are common side effect due to androgen ablation therapy (AAT). The utility of acupuncture for hot flashes in men has not been thoroughly studied. We prospectively studied the effect of acupuncture in men with hot flashes. METHODS AND MATERIALS: The study was approved by internal review board. Seventeen men with hot flashes and history of AAT for prostate cancer were enrolled. Three men declined participation before receiving any treatment. A hot flash score (HFS) was used to measure daily hot flashes. The composite daily score was calculated as the product of frequency × severity. The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up. RESULTS: No side effects were encountered during, immediately after treatment, or at 8 months. The mean initial HFS was 28.3; it dropped to 10.3 (p = 0.0001) at 2 weeks posttreatment, 7.5 (p = 0.0001) at 6 weeks, and 7.0 (p = 0.001) at 8 months. Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point. The mean improvement at Weeks 2 and 6 was 68.4% (mean HFS decreased from 37.409 to 11.836, p = 0.001) and 89.2% (mean HFS decreased from 37.409 to 4.05, p = 0.0078) respectively. The improvement at 8 months was 80.3% (mean HFS decreased from 37.409 to 7.385, p = 0.002). CONCLUSIONS: Acupuncture provides excellent control of hot flashes in men with a history of AAT. The absence of side effects and the durable response at 8 months are likely to be appealing to patients. Prospective randomized study is warranted to further evaluate this modality against medical therapy.