Facts & Findings

• Expanding Medicaid May Mitigate Disparities in Pancreatic/Gastric Cancers  

According to research presented in a press conference prior to the 2023 ASCO Annual Meeting, patients with pancreatic cancer experienced better survival outcomes and existing survival disparities were minimized as a result of expanded Medicaid coverage. In their study, Manisundaram and colleagues compared mortality rates for patients with gastrointestinal cancers by race and state before and after Medicaid expansion using data from the National Cancer Database. Their findings showed that for both Black and white pancreatic cancer patients, states that extended Medicaid had better survival rates than states that did not, including for people with late-stage disease. Particularly, Black patients in states with Medicaid expansion saw an 11.8% drop in 2-year death rates, compared to a 2.4% drop in areas without the expansion (Dobkowski). Manisundaram stated that “Black patients in expansion states with stage IV disease experienced a net increase in receipt of surgery following Medicaid expansion compared to patients in non-expansion states.” Black patients in expansion states experienced increases in receipt of chemotherapy as well. This analysis aligns with the current research that expanding Medicaid improves access among cancer patients to screening, treatment, and other care. The study will be presented and further discussed at the ASCO Annual Meeting.

 

• Uridine-Derived Ribose Fuels Glucose-Restricted Pancreatic Cancer

The tumor microenvironment (TME) of pancreatic cancer largely contributes to the lethality of the disease. Components of the TME contribute to low oxygen saturation, therapeutic resistance, metabolic alterations, and heterogeneity within the tumor. Pancreatic cancer cells surviving in such an environment exhibit metabolic adaptations that increase their scavenging and catabolic capabilities (Nwosu et al.). When pancreatic tumors can’t access nutrients like glucose, they look for other nutrients to serve as a fuel source. The range of nutrients used by pancreatic cancer cells is poorly understood. Using a screening technology, Nwosu and colleagues at the University of Michigan Rogel Cancer Center addressed this by studying what nutrients support pancreatic cancer growth. They discovered that when glucose is scarce, pancreatic cancer cells use the molecule uridine as a nutrient source to grow (Blocking Uridine Enzyme). This observation suggests that uridine may be a new therapeutic target for pancreatic cancer and should be further investigated.

 

• Pancreatic Cancer Biopsy Modalities: Comparing Insurance Status, Length of Stay, and Hospital Complications Based on Percutaneous, Endoscopic, and Surgical Biopsy Methods

There are several ways that pancreatic cancer is diagnosed including surgical biopsy (SB), CT or ultrasound-guided percutaneous core needle biopsy (PB), or endoscopic biopsy (EB) The factors and outcomes associated with each method have not been well studied. To address this, Mittal and colleagues collected information from the National (Nationwide) Inpatient Sample (NIS) to evaluate the relationship between insurance status, length of hospital stay, complications, and different pancreatic biopsy modalities. They found that both uninsured and Medicaid patients were more likely to undergo PB, and less likely to undergo SB, despite a lack of guidelines as to how to choose between them, suggesting a possible disparity in access to care (Mittal et al.) Furthermore, patients who underwent EB had the shortest length of hospital stay compared to those who underwent PB, SB, or combination biopsies, and each biopsy method was associated with different complications. In terms of the types of complications patients experienced, the researchers considered demographic variables as well. They discovered that African Americans were more likely to develop acute renal failure, a urinary tract infection, and pancreatitis as a complication of biopsy.

 

• The Link Between Sodium and Pancreatic Disease

High sugar intake has already been linked to the development of pancreatic cancer. Researchers are beginning to study the impact of sodium. Like sugar, a high sodium diet has been associated with many health conditions including obesity and diabetes, two of the biggest risk factors for pancreatic cancer. Research shows that there are many reasons why African Americans are at an increased risk for developing the disease, but dietary factors play a large role. According to the National Pancreas Foundation, 31% of Black/African American men and 44% of Black/African American women are obese, and Black/African American adults are 60% more likely to have diabetes than non-Hispanic white adults. Thus, by reducing sodium intake and unhealthy foods, people lower their risk of developing these conditions associated with pancreatic cancer.

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Environmental and sociodemographic factors that affect African Americans can create barriers to eating healthy. For example, food deserts are more common in Black communities. Ways to eat healthy on a budget include frozen or canned vegetables without added salt; frozen or canned fruits without added sugars; whole grains, such as brown rice, bought in bulk; dried beans peas and lentils; canned tuna; nuts; and eggs (The National Pancreas Foundation).