Disparities Drive Shifting Pancreatic Cancer Survival Trends

Complex demographic and geographic disparities are influencing pancreatic cancer outcomes across the US, pointing to needs for broad public health interventions, targeted prevention strategies, and improved resource allocation to combat the shifting patient survival landscape of this malignancy. A trio of abstracts presented at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium exhibit mortality outcomes from this sixth-leading cause of cancer-related mortality worldwide,1 through patient outcomes information from a high-volume treatment area and mortality hotspots in the South and Midwest regions.1-3

These data from the CDC, the University of Texas MD Anderson Cancer Center, and the Institute for Health Metrics and Evaluation cover 1990 to 2024 and examine the pancreatic cancer burden across the intersections of rural and urban populations, races and ethnicities, and age and sex.

Pancreatic Cancer in Rural Areas1

Incorporating data from CDC WONDER (Wide-ranging ONline Data for Epidemiologic Research) on deaths of adults 25 years and older (N = 1,002,439), researchers focused on age-adjusted mortality rates (AAMRs) per 100,000 population for 1999 to 2023 for urban (n = 698,805) and rural (n = 148,558) areas; remaining deaths were in another area. Overall, the AAMR was 17.66 (95% CI, 17.25-18.45) and it underwent a 0.33% average annual percent change (AAPC).

Although the AAMRs are close to equal when stratifying by rural (17.69; 95% CI, 17.03-18.96) vs urban (17.62; 95% CI, 17.30-18.02) location overall, the AAPCs are separated by an immense gap: 0.77% vs 0.20%, with the mortality rate in rural areas surpassing urban areas by 2010, having undergone a sustained sharp increase beginning in 2003 after an initial decline of 0.26%. Most patients died in their home (n = 484,428), followed by inpatient medical facility (n = 235,927), nursing home (112,874), hospice (n = 93,638), and outpatient medical facility (n = 16,681).

With pancreatic cancer mortality trending upward in rural areas, the investigators see a need for region-specific prevention strategies that focus on improving access to early diagnosis and oncologic care delivery.

Pancreatic Cancer Treatment Receipt2

Knowing that persistent unequal survival rates among minoritized races and ethnicities compared with a non-Hispanic White (NHW) population stem from inadequate access to specialized care, a team at MD Anderson wanted to see if similar trends were evident at their institution. For 2016 to 2024, they gathered data on pancreatic adenocarcinoma (N = 3249) from their cancer registry, pharmacy database, and electronic health record, and analyzed 90-day evaluation, treatment modality, and overall survival (OS). Minority patients were Asian (7%; n = 233), Black (10%; n = 318), and Hispanic (12%; n = 12%); the rest were NHW.

These data from the CDC, MD Anderson, and the Institute for Health Metrics and Evaluation examine the pancreatic cancer burden across the intersections of rural and urban populations, races and ethnicities, and age and sex. | Image Credit: © Vitalii Vodolazskyi-stock.adobe.com

Before accounting for patient and disease characteristics, disparities were evident in chemotherapy delivery (P < .001), most often seen in Asian patients (92%) vs Black patients (83%). Trial enrollment was also lower in Black (25%; P < .001) and Hispanic (30%; P = .043) vs NHW (38%) patients. Median OS differed, too. In Asian patients, it was 26.6 months; in NHW patients, 20.7 months; Hispanic patients, 18.6 months; and Black patients, 17.4 months. The median follow-up was 33.1 months, and NHW patients were most likely to be seen within 3 months of diagnosis vs Black (adjusted OR [AOR], 1.67), Hispanic (AOR, 1.72), and Asian (AOR, 2.06) patients.

After accounting for age, performance status, comorbidity index, first-line chemotherapy, and tumor location, within the racial and ethnic minoritized groups, there were survival disadvantages, lower rates of chemotherapy receipt, and lower clinical trial enrollment. However, survival rates did not significantly differ between the racial and ethnic minoritized groups and the NHW patients overall. Everyone, the authors highlighted, received timely evaluation and standard-of-care treatment.

Pancreatic Cancer Burden3

Using Institute for Health Metrics and Evaluation Global Burden of Disease 2021 results, these researchers investigated where and when this cancer burden is greatest, for guidance on improving prevention, detection, and equitable care efforts. Disability-adjusted life-years (DALYs) and temporal risk factor rankings from 1990 to 2021 were used to attribute risk.

Per 100,000 population, highest and lowest rates for each measure were compared. For 2021, the greatest burden overall was consistently seen in the South and Midwest, when considering these measures:

• Incidence: 12.93 for Louisiana vs 8.78 for North Dakota
• Prevalence: 11.46 for Hawaii vs 8.83 for Montana
• Mortality: 12.39 for Louisiana vs 8.08 for North Dakota
• DALYs: 281.6 for Louisiana vs 177.4 for Colorado
• Male incidence: 14.46 for Louisiana vs 10.04 for North Dakota
• Female incidence: 11.53 for Louisiana vs 7.55 for North Dakota

Results by age and sex showed that male patients fared worse at younger ages vs female patients, at 65 to 69 years vs 80 years and older, but that both groups did experience jumps in incidence after age 65. Looking, too, at age younger than 20 years vs 80 years and older, cases were 2.3 and 6651 in male patients, respectively, and 2.1 and 9332 in female patients.

The authors noted these disparities in a growing survivor population mean more and older patients with long-term care needs, indicating hotspots could be better identified by integrating social determinants when building prevention strategies and considering policy interventions.

References

1. Shariar Z, Hemida MF, Ibrahim AA, et al. Rural-urban disparities in pancreatic cancer mortality hotspots in the United States. Presented at: American Society of Clinical Oncology Gastrointestinal Cancers Symposium; January 8-10, 2026; San Francisco, CA. Abstract 661.
2. Lewis KA, Yousef MM, Prakash L, et al. Racial and ethnic differences in pancreatic cancer survival and treatment at a high-volume center. Presented at: American Society of Clinical Oncology Gastrointestinal Cancers Symposium; January 8-10, 2026; San Francisco, CA. Abstract 662.
3. Adusumilli MB, Gundapaneni SRC, Mullaguri S, et al. Disparities in pancreatic cancer burden across states, sex, and risk factors: a GBD 2021 study. Presented at: American Society of Clinical Oncology Gastrointestinal Cancers Symposium; January 8-10, 2026; San Francisco, CA. Abstract 669.