Abstract
BACKGROUND AND AIMS: The COVID-19 pandemic led to delayed treatment for pancreatic ductal adenocarcinoma (PDAC) and other cancers due to factors such as lockdown protocols, social distancing practices, and prioritization of emergency procedures. Demographic factors create disparities in pancreatic cancer care access, further impacting time to treatment. Prolonged time to treatment initiation has been associated with worse health outcomes for patients with solid tumor malignancies, particularly PDAC. Communities at higher risk of PDAC were disproportionately affected by the pandemic due to factors including residence in healthcare deserts, inadequate insurance, and low health literacy. This study aims to investigate whether racial disparities in time to treatment for PDAC were exacerbated during the COVID-19 pandemic, with particular attention to vulnerable populations. METHODS: National Cancer Database (NCDB) data were utilized to identify patients diagnosed with PDAC between 2018 and 2020. Patients were categorized as either "pre-COVID" (2018) or "post-COVID" (2020). A two-way ANOVA and post hoc testing were conducted with time to treatment as the primary dependent variable. RESULTS: A statistically significant relationship was identified between race and time to treatment (F = 7.16, p < 0.001). Post hoc tests revealed significant differences (p < 0.001) between White and Black patients, with Black patients experiencing greater delays both before and after COVID-19. The interaction between time of diagnosis and race had a statistically significant impact on time to treatment (F = 1.68, p = 0.03), indicating that certain races experienced greater delays than others. Chinese patients experienced the most significant increase in time to treatment, with an average delay extending by 7.8 days from 2018 to 2020 (p = 0.046). CONCLUSION: The analysis revealed significant relationships between race, time of diagnosis, and time to treatment, with Chinese patients experiencing the most substantial increase in treatment delay during the pandemic. These findings demonstrate how COVID-19 disruptions intensified preexisting healthcare inequities and highlight the need to address demographic disparities in healthcare access.