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Disparities in Surgical Oncologic Care

Disparities Poster Presentations

P19: Impact of Social Determinants of Health on Delayed Postoperative Adjuvant Therapy Among Patients Undergoing Resection of Pancreatic Cancer

Friday, March 22, 2024
3:27pm – 3:33pm ET
Location: SSO HUB Theater
Disclosure(s):
Mujtaba Khalil, MD: No financial relationships to disclose
Introduction: Pancreatic cancer (PC) treatment requires a multi-modality approach. Specifically, guideline concordant care routinely includes adjuvant chemotherapy (aCT). We sought to define how social determinants of health (SDOH) impacted delayed or non-receipt of aCT among patients undergoing PC resection.


Methods: Patients who underwent PC resection between 2014 and 2020 were identified from the 100% Medicare Standard Analytic Files. Data were merged with the county-level Social Vulnerability Index (SVI). SVI subthemes included socioeconomic (SE), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation (HTT). aCT was considered delayed if administered more than 12 weeks after surgery. Mediation analysis was used to define which specific SDOH subthemes were responsible for any possible association of SVI with aCT receipt.


Results: Among 24,078 Medicare beneficiaries, median age was 69.0 years [IQR 64.0 – 74.0], roughly half were male (male: n=12,333, 51.2%), and the majority was White (n= 20,686; 85.9%). Following PC resection, 11,489 (47.7%) patients received timely aCT, while 4,267 (17.7%) received delayed aCT; of note, 8,322 (34.6%) patients did not receive any aCT. On multivariable analysis, high social vulnerability was associated with higher odds of both delayed (OR 1.20, 95%CI 1.09–1.32) and failure to receive any (OR 1.28, 95%CI 1.18 – 1.39) aCT (high vs. low SVI; both p< 0.05). On mediation analysis, 76.7% of the variation in timely receipt of aCT was directly attributable to social vulnerability, while 26.9% of the SVI effect was related to indirect mediators such as hospital volume (6.9%), length-of-stay (9.2%), and post-operative complications (7.2%) (Figure). When SVI effect was deconstructed, SE (delayed aCT: OR 1.23, 95%CI 1.12–1.36; non-receipt aCT: OR 1.23, 95%CI 1.13–1.34) and HCD (delayed aCT: OR 1.29, 95%CI 1.17–1.43; non-receipt aCT: OR 1.19, 95%CI 1.09–1.30) had the most impact on aCT receipt (all p< 0.001).  Other SDOH such as MSL (OR 1.16, 95%CI 1.06–1.27) and HTT (OR 1.12, 95%CI 1.03–1.21) were also associated with non-receipt of aCT (both p< 0.05).


Conclusions: Among patients with delayed or non-receipt of aCT, SDOH primarily accounted for most of the variation in care after PC resection. Particularly, delay or non-receipt of aCT was directly attributable to SE and HCD more so than post-operative complications. SDOH focused interventions are needed to improve guideline concordant PC care and decrease health care disparities.

Learning Objectives:

  • Upon completion, participants will be able to describe how social determinants of health impact delayed or non-receipt of adjuvant chemotherapy among patients undergoing pancreatic cancer resection.
  • Upon completion, participants will be able to define social determinants of health that need to be focused on to improve guideline-concordant care and decrease health care disparities.
  • Upon completion, participants will be able to describe direct impact of social vulnerability as well as factors that mediate indirect effect of SVI on delayed or nonreceipt of adjuvant chemotherapy.