Evaluation of Endoscopic Ultrasound Delays in the Diagnosis of Pancreatic Cancer in Older Adults in the United States

Introduction: Pancreatic cancer is among the most aggressive malignancies, with a 5-year survival rate of 10%. Most patients present with advanced disease, limiting curative treatment options. Endoscopic ultrasound with fine-needle biopsy (EUS-FNB) is the standard for diagnosis and staging. While early access to EUS may enable timely systemic therapy and improve resectability; uncertainty remains regarding how delays to EUS impact surgical resection rates and overall survival, particularly in older adults. We aimed to identify factors associated with delayed EUS and to evaluate its impact on surgical resection and overall survival. Methods: Using national Medicare claims (2011–2020), we conducted a retrospective cohort study of beneficiaries aged ≥66 years with newly diagnosed pancreatic cancer The index date was the most recent claim for a pancreatic lesion or abnormal liver enzymes, serving as the indicator for EUS referral. Delay to EUS was defined as >30 days between the index date and the EUS procedure. Multivariable logistic regression identified sociodemographic and clinical factors associated with delayed EUS. Cox proportional hazards models estimated the associations between delayed EUS and two outcomes: (1) pancreatic surgical resection and (2) all-cause mortality. Results: Among 2,843 patients, 586 (20.6%) experienced a delay in EUS, 774 (27.2%) underwent surgery, and 1,591 (56.0%) died. Black patients were more likely to experience delay (aOR 1.65, 95%CI 1.09–2.51), while those with more comorbidities were less likely (aOR 0.95, 95%CI 0.90–0.99). Delayed EUS was associated with a lower likelihood of surgery (HR 0.73, 95%CI 0.61–0.88) but lower mortality (HR 0.58, 95%CI 0.50–0.66). Mortality increased with older age (HR 1.43, 95%CI 1.27–1.61) and comorbidity (HR 1.04, 95%CI 1.02–1.07). Conclusions: Timely EUS was associated with higher surgical resection rates, suggesting earlier access to curative treatment. Lower mortality among patients with delayed EUS possibly reflects disease severity confounding rather than benefit.