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Hepato-pancreato-biliary

E255: The Impact of Neighborhood Socioeconomic Deprivation on Treatment for Resectable Pancreatic Cancer Patients in Florida: An Incidence-Based Retrospective Cohort Study

Introduction: Many studies show early-stage pancreatic cancer is undertreated in the U.S. While socioeconomic status (SES) often influences treatment disparities, research typically assesses SES using broad geographic markers like zip codes. Using a statewide cancer registry, we examined disparities from neighborhood-level socioeconomic deprivation (SED). We hypothesize higher neighborhood SED links to lower surgery and multimodal treatment rates in patients with resectable pancreatic cancer.

Methods: The Florida Cancer Data System includes 16,319 patients diagnosed with pancreatic adenocarcinoma from 2008 to 2015. Of these, 4,323 had resectable cancer based on AJCC stage and collaborative stage extent and were surgery eligible. The Area Deprivation Index, a dataset ranking neighborhoods nationally from 1-100 (higher scores mean greater deprivation), gauged stage at diagnosis and treatment by quintile. Descriptive statistics, association tests, and logistic regression informed our analysis.

Results: The median national SED rank for resectable pancreatic cancer patients was 54. SED was linked with factors like sex, race, insurance status, surgery, chemotherapy, radiation, and multimodal treatment (surgery and chemotherapy combined), all at p< 0.05. SED had no link with age, ethnicity, or AJCC clinical stage (stage I at 27.9%, stage II at 72.1%). Cohort treatment rates were surgery (56.4%), chemotherapy (51.8%), and multimodal (36.6%). Only 4.8% had neoadjuvant chemotherapy. The lowest SED quintile saw surgery and chemotherapy rates at 63.0% and 39.5% versus 50.8% and 26.5% in the highest. 45.7% in the lowest quintile had multimodal treatment, versus 30.9% in the highest. After adjustment, the lowest SED quintile had higher odds for curative surgery and multimodal treatment (OR 1.66; 95% CI, 1.35-2.05 and OR 1.86; 95% CI, 1.49-2.31).

Conclusions: Half of resectable pancreatic cancer patients did not receive surgery, and nearly two-thirds missed multimodal treatment. Higher neighborhood SED correlated with fewer surgeries and treatments. Addressing these disparities requires exploring challenges and opportunities to improve guideline concordant. care for higher SED patients.

Learning Objectives:

  • Define and describe the concept of neighborhood-level socioeconomic deprivation (SED) and how it differs from broader measures like zip codes.
  • Evaluate the overall rates of different treatment modalities (surgery, chemotherapy, multimodal treatment) among individuals with resectable pancreatic cancer.
  • Explore the necessity for policy changes, community engagement, and healthcare system improvements to address treatment disparities and enhance cancer care outcomes in socioeconomically deprived areas.