Examining the determinants and consequences of supportive care medication use disparities in patients with pancreatic cancer: A sequential mixed-methods approach

PROJECT SUMMARY Pancreatic cancer (PC) is a significant public health issue and is the third leading cause of cancer deaths in the U.S. PC is associated with significant neurologic and psychiatric morbidities, which are associated with reduced health-related quality of life (HRQoL). Supportive care medications (SCM) are the foundation to managing PC-

related neurologic and psychiatric symptoms and thus improving HRQoL. Multiple PC studies have demonstrated worsened HRQoL in racial/ethnic minorities. Prior research evaluating the impact of race/ethnicity on SCM use in cancer indicated that racial/ethnic minorities were less likely to be prescribed several types of

SCM. However, the studies did not assess the contextual-level social determinants of health (SDoH), the quality of SCM used, nor the impact of social or cultural factors on SCM use. Thus, to our knowledge, no research has examined causal paths of racial disparities in SCM use in PC, or assessed their impact on HRQoL, leaving

significant knowledge gaps. The long-term goal of our research is to optimize medication use and improve HRQoL in patients with cancer. The overall objectives of this application are to (i) elucidate the relationship between race/ethnicity and other sociodemographic factors and the use of SCM, (ii) evaluate if there are

differences in the quality of SCM between racial/ethnic groups, and (iii) describe the sociocultural and psychosocial factors that influence SCM use in racial/ethnic minorities. The central hypothesis motivating this research is that racial/ethnic disparities in SCM use exist in PC, and contribute to HRQoL racial disparities in

patients with PC. The rationale for this project is that there is a critical need to understand SCM use disparities across racial/ethnic minorities, and identify potential drivers. The central hypothesis will be tested by pursuing three specific aims: (1) Derive a sociobehavioral phenotype that explains SCM use disparities in racial and ethnic

minorities with PC; (2) Determine how SCM sociobehavioral phenotype, SCM use, and race influence HRQoL and (3) Identify facilitators of and barriers to SCM use in patients with PC. For aims 1-2, we will use quantitative methods to determine population-level racial/ethnic health care disparities from analysis of the NCI SEER-

Medicare, and SEER-Medicare Health Outcomes Survey linked databases and a contextual-level SDoH database from the social and built environment. Aim 3 uses key informant interviews of PC patients, and providers to evaluate the influence of SDoH, psychosocial, and sociocultural factors on SCM use. This project is

highly innovative because it will be the first to derive a sociobehavioral phenotype of SCM use disparities in PC using a novel integrated external exposome database that captures multiple dimensions of SDoH. It is also highly impactful because it will provide new insights into the explanatory causes of SCM disparities, their consequences

on HRQoL, and the facilitators and barriers to SCM use from multiple perspectives. Ultimately, such knowledge can lead to new discoveries, including SCM prescribing patterns and influences on utilization, and may be applied to other cancer types with high morbidity, mortality, and disproportionate impact on racial minorities.