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INTRODUCTION: Pancreatic cancer remains one of the deadliest cancers in the United States. Some types of pancreatic cysts, which are being detected more frequently and often incidentally on imaging, have the potential to develop into pancreatic cancer and thus provide a valuable window of opportunity for cancer interception. Although racial disparity in pancreatic cancer has been described, little is known regarding health disparities in pancreatic cancer prevention. In the present study, we investigate potential health disparities along the continuum of care for pancreatic cancer. METHODS: The racial and ethnic composition of pancreatic patients at high-volume centers in Indiana were evaluated, representing patients undergoing surgery for pancreatic cancer (n=390), participating in biobanking (972 pancreatic cancer patients and 1984 patients with pancreatic disease), or being monitored for pancreatic cysts at an early detection center (n=1514). To assess racial disparities and potential differences in decision-making related to pancreatic cancer prevention and early detection, an exploratory online survey was administered through a volunteer registry (n=708). Results: We show that despite comprising close to 10% or 30% of the Indiana or Indianapolis population, respectively, African Americans make up only about 4-5% of our study cohorts consisting of patients undergoing pancreatic surgery or participating in biobanking and early detection. Analysis of online survey results revealed that given the hypothetical situation of being diagnosed with a pancreatic cyst or pancreatic cancer, the vast majority of respondents (>90%) would agree to undergo surveillance or surgery, respectively, regardless of race. Only a minority (3-12%) acknowledged any significant transportation, financial, or emotional barriers that would impact a decision to undergo surveillance or surgery. This suggests that the observed racial disparities may be due in part to the existence of other barriers that lie upstream of this decision point. CONCLUSION: Racial disparities exist not only for pancreatic cancer but also at earlier points along the continuum of care such as prevention and early detection. To our knowledge, this is the first study to document racial disparity in the management of patients with pancreatic cysts who are at risk of developing pancreatic cancer. Our results suggest that improving access to information and care for such at-risk individuals may lead to more equitable outcomes.
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BACKGROUND: Success in the residency interview is important in obtaining a position in general surgery residency. Preparing applicants for interviews is imperative yet can be resource intensive. The primary objective of our study was to investigate whether an early interview day with feedback (IDWF) provides interview preparation to internal applicants to general surgery residency without negatively impacting their rank list position at our program. METHODS: Internal applicants to the general surgery residency program at a single academic institution were invited to an early interview day after which they received individualized feedback and attended a workshop on interview techniques. Applicants were anonymously surveyed after The Match to measure their experiences with the IDWF. Two years of post-intervention program rank lists were compared to those from the five years pre-intervention to assess for change in rank list position of internal applicants. Participants included the 16 of 20 internal applicants who completed the survey. De-identified rank order data of internal applicants between 2014 and 2020 included 48 applicants. RESULTS: All applicants believed the IDWF should be continued, and over half reported improved confidence and made changes from feedback. Rank list analysis demonstrated no statistically significant change in the proportion of internal applicants who ranked in the top 40 nor the average rank position of internal applicants. CONCLUSIONS: An early interview day with feedback provides interview preparation in a resource-efficient manner without harming rank list position. The IDWF may be generalizable to other institutions to provide interview preparation to general surgery residency applicants.
