Safety Net Hospitals May Confer Worse Survival for Pancreatic and Biliary Cancer Patients

Strategic Insights -

Cancer patients who undergo surgery at hospitals serving a large number of Medicaid patients, known as "safety net" hospitals, may have worse survival rates for pancreatic and biliary cancer compared to those receiving care at other institutions, according to a recent study. The research, conducted by a team of surgeons and researchers from Boston Medical Center, used data from the National Cancer Database to analyze patterns and outcomes of curative intent surgery for these complex cancers. By examining the relationship between Medicaid-serving hospitals and patient outcomes, the study aimed to better understand the disparities in cancer care.

Key Takeaways:

  • The study analyzed data from 2004 to 2021, encompassing over 14,000 patients who underwent curative intent surgery for pancreatic and biliary cancer.
  • Researchers identified four quartiles of Medicaid-serving hospitals, with the highest quartile representing "safety net" institutions.
  • Patients treated at "safety net" hospitals had similar survival rates for pancreatic and biliary cancer compared to those receiving care at other institutions.
  • Logistic regression analysis revealed that predictors for undergoing curative intent surgery included older age, stage IV disease, and Charlson Comorbidity Index scores.
  • Cox proportional regression models showed that survival rates were similar for patients treated at "safety net" hospitals compared to those receiving care at other institutions.
  • The study's findings suggest that the traditional definition of "safety net" hospitals may be skewed toward academic centers, where rare and complex cases like pancreatic and biliary cancer are more likely to be managed.
  • The research has implications for understanding disparities in cancer care and highlights the need for more comprehensive measures of hospital safety net status.

Statistics:

  • 14,345 patients underwent curative intent surgery for pancreatic and biliary cancer between 2004 and 2021.
  • Patients treated at "safety net" hospitals accounted for approximately 34% of cases.
  • Logistic regression analysis identified 14 predictors for undergoing curative intent surgery, including age (OR 1.13), stage IV disease (OR 3.21), and Charlson Comorbidity Index score (OR 2.21).
  • Cox proportional regression models showed that survival rates were similar for patients treated at "safety net" hospitals and those receiving care at other institutions (HR 0.83, 95% CI 0.49-1.40).

Sources:

  • The Real Safety Net Hospitals: High-medicaid Hospitals Confer Worse Survival for Patients Undergoing Pancreas and Biliary Cancer Surgery. Annals of Surgical Oncology, 2025.
  • Teviah E. Sachs, et al. Study Findings from Boston Medical Center Broaden Understanding of Cancer. Cancer Weekly. August 26, 2025; p 93.