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Disparities in Surgical Oncologic Care

E147: Understanding fragmented pancreatic cancer care: Are sociodemographic disparities predictive of patients receiving fragmented care?

Introduction: Fragmented Care (FC), care at multiple centers, is an emerging area of study in oncologic care. We examined a cohort of pancreatic cancer patients with upfront surgical resection to evaluate if sociodemographic disparities play a predictive role in receiving FC.

Methods: Patients with pancreatic adenocarcinoma from 2008 to 2022 with surgery first were queried from a single NCI designated cancer center. FC groups were defined by location of care including diagnosis and surgery: no FC, FC with patient receiving care at same facility level (SFL) hospital (e.g., academic to academic hospitals), FC with patient transferring care from academic facility (AF) to community facility (CF), and FC with patient transferring care from CF to AF. Predictors included age at diagnosis, race/ethnicity, median household income (MHI) (from census.gov), and social vulnerability index (SVI) score (CDC.gov scale per county of socioeconomic status, household characteristics, minority status, and housing/transportation). SVI score is graded on a scale of 0 to 1 with 0 the lowest and 1 the highest vulnerability. 

Results:

Out of 256 patients with pancreatic adenocarcinoma, 141 patients had upfront surgery. 66 patients (47%) had no FC, 43 patients (31%) had FC at SFL, 29 patients (20%) had FC with AF to CF, and 3 patients (2%) had FC from CF to AF. Median age at diagnosis for no FC group was 68.0 (IQR 61.0 to 72.0), FC at SFL 67.0 (IQR 57.0 to 73.0), FC with AF to CF 60.0 (IQR 55.0 to 67.0), and FC with CF to AF 74.0 (IQR 73.0 to 78.0). Increased age at diagnosis was predictive of receiving FC (p=0.0492). Caucasian patients made up 92.4% of no FC group, 86.0% of FC with SF level, 62.1% of patients in FC from AF to CF, and 100% of FC from CF to AF. Non-Hispanic black patients made up 6.1% of no FC group, 9.3% of FC with SFL, and 24.1% of patients in FC with AF to CF. Hispanic patients made up 0% of no FC group, 2.3% of FC at SFL, and 24.1% of patients with FC from AF to CF. Race/ethnicity was independently associated with patients receiving FC (p= 0.036).
Though SVI was lowest in no FC groups and FC where patients presented from CF to AF, SVI was not predictive of FC (p=0.51). MHI was also not a significant predictor of FC (p=0.79). The MHI was $81,395 in patients with no FC, $87,441 in SFL FC, $76,977 in AF to CF FC, and $83,110 in CF to AF FC.

Conclusions:

Age and race/ethnicity were both independently associated with FC. MHI and SVI distributions show a trend toward decreased income and increased vulnerability in FC at different facility level.

Learning Objectives:

  • Upon completion, participants will be able to define fragmented care and explain its significance in the context of oncologic care.
  • Upon completion, participants will be able to list and describe sociodemographic predictors that play a role in determining whether a patient receives fragmented care.
  • Upon completion, participants will be able to analyze the results of the study, identifying the relationships between age, race/ethnicity, MHI, SVI, and the likelihood of receiving fragmented care.