Quality Score Among Patients With Metastatic Pancreatic Ductal Adenocarcinoma: Trends, Racial Disparities, and Impact on Outcomes

Background: Evaluation of the quality of care delivered to patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) has been limited. We sought to examine trends and racial/ethnic disparities in quality of care among patients with mPDAC as well as the impact on outcomes using a novel and easily applied quality metric. Methods: Medicare beneficiaries diagnosed with mPDAC between 2005 and 2019 were identified using SEER-Medicare data. Achievement of a quality score based on 3 criteria was assessed: (1) cancer-specific survival (CSS) >12 months, (2) receipt of systemic therapy, and (3) utilization of hospice/palliative care services. We examined factors associated with achieving the quality score, including race/ethnicity, social vulnerability index (SVI), and year of treatment. The impact of the quality score on CSS was also analyzed. Results: Among 14,147 patients with mPDAC, 62.2% (n=8,794) received systemic therapy, 83.3% (n=11,791) utilized palliative care/hospice services, and 13.7% (n=1,933) had CSS >12 months after diagnosis. Achievement of at least one quality criterion increased over time (from 84.5% in 2005 to 97.0% in 2019; P <.001). Multivariable analysis showed that a high overall SVI (odds ratio [OR], 0.70; 95% CI, 0.54–0.91) was independently associated with lower odds of meeting at least one quality criterion. This effect was mainly driven by the SVI subthemes of high socioeconomic status (OR, 0.66; 95% CI, 0.48–0.90) and high racial/ethnic minority status (OR, 0.75; 95% CI, 0.60–0.93). Achievement of quality score ≥1 (excluding CSS criterion) was associated with improved overall survival (1-year CSS, 14.5% vs 3.2%; P <.001). Conclusions: Approximately 9 in 10 patients with mPDAC achieved at least one of the quality score criteria, though racial/ethnic minority patients and socially vulnerable populations had lower achievement. Lower quality score achievement was associated with poorer long-term survival. These findings highlight the need for targeted interventions to meet quality metrics for all patients with mPDAC to mitigate disparities in end-of-life care.