Unveiling inequalities: An analysis of treatment disparities of primary gallbladder neuroendocrine tumors by race, ethnicity, and socioeconomic status from the National Cancer Database.

Aleenah Mohsin Lifespan Cancer Institute/Brown University School of Medicine-Rhode Island Hospital, Providence, RI info_outline Aleenah Mohsin, Mohammad Arfat Ganiyani, Shahzaib Ahmad, Vivek Podder, Rohan Garje

Authors Aleenah Mohsin Lifespan Cancer Institute/Brown University School of Medicine-Rhode Island Hospital, Providence, RI info_outline Aleenah Mohsin, Mohammad Arfat Ganiyani, Shahzaib Ahmad, Vivek Podder, Rohan Garje Organizations Lifespan Cancer Institute/Brown University School of Medicine-Rhode Island Hospital, Providence, RI, Miami Cancer Institute, Baptist Health South Florida, Miami, FL Abstract Disclosures Research Funding No funding sources reported Background: Gallbladder neuroendocrine tumors (NETs) are exceedingly rare tumors and carry a poor prognosis. Racial/ethnic disparities and socioeconomic status have been known to influence cancer treatment and outcomes. This study explores racial/ethnic and socioeconomic disparities in treatment patterns of primary gallbladder NETs, focusing on factors affecting receipt of chemotherapy and multimodal therapy. Methods: We analyzed primary gallbladder NETs patients using the National Cancer Database (NCDB) from 2004 to 2020. Racial groups were divided into White and Black categories, and then those groups were further divided into Hispanic White, non-Hispanic White, Hispanic Black, and non-Hispanic Black categories according to ethnicity. We considered socioeconomic factors, tumor histology, and facility type. Logistic regression was used to determine the odds of receiving chemotherapy and multimodality therapy. The significance of disparities was determined using odds ratio (OR) and p-value . Results: Of 1,195 primary gallbladder NET patients, 59% (708 patients) underwent surgery. These patients had a median age of 65 years, with a female majority (64%) and predominantly White ethnicity (73.6%). Insurance coverage varied, with 48.9% having Medicare and 35.6% private insurance, while 3.9% were uninsured and 8.6% were covered by Medicaid. The study highlighted key factors affecting the receipt of surgery. Notably, racial disparities were apparent, with Black patients less likely to receive surgery compared to White patients (OR: 0.52; P < .001). Furthermore, patients with typical carcinoid tumors were markedly more likely to receive surgery than those with other histology (OR: 10.93; P < .001). The type of treatment facility was influential, with patients in Academic/Research Programs more likely to receive surgery (OR: 0.41; P < .001) than those in Community Cancer Programs. Conclusions: This study highlights racial and socioeconomic disparities in chemotherapy and multimodality therapy for gallbladder NETs, with Black, uninsured, and Medicaid-insured patients less likely to receive treatment. These findings call for targeted policy and healthcare reforms to ensure equitable access and outcomes for all patients with this condition. Characteristics All Patients [n = 1195] Median age, years 65 Sex Female 765 (64) Male 430 (36) Race/Ethnicity Non-Hispanic White 727(68.9) Non-Hispanic Black 210(19.9) Hispanic 130(11.4) Asian Insurance status Private 424(35.6) Medicare 583(48.9) Medicaid 102(8.6) Uninsured 47(3.9) Income* < $63,000 706(65.8) ≥$63,000 367(30.8) Educational Attainment < 7% 232(28.9) 7%-20% 347(40.8) ≥21% 242(32.2) Charlson-Deyo Score 0 817(68.4) 1 252(21.1) ≥2 126(10.5) Tumor histology Neuroendocrine carcinoma 400(33.5) Small cell neuroendocrine carcinoma 386(33.2) Large cell neuroendocrine carcinoma 115(9.6) Typical carcinoid 294(24.6) Median tumor size, mm 107 AJCC stage I 15(1.2) II 11(0.9) III 93(7.8) IV 335(28.1) Positive regional nodes Yes 192(61.5) No 120(38.5) Tumor grades 1 126(10.5) 2 21(1.8) 3 or undifferentiated 383(32.0) Site of metastasis Liver 304(25.4) Bone 37(3.0) Lung 17(1.4) Brain 8(0.6) Unspecified 45(3.8)