Adjuvant therapy rates and overall survival in patients with localized pancreatic cancer from high Area Deprivation Index neighborhoods. Am J Surg 2021 Jul;222(1):10-17
Date
12/15/2020Pubmed ID
33308823DOI
10.1016/j.amjsurg.2020.12.001Scopus ID
2-s2.0-85097458297 (requires institutional sign-in at Scopus site) 59 CitationsAbstract
BACKGROUND: Neighborhood adversity's impact on postoperative/adjuvant therapy delivery and overall survival (OS) is poorly described in patients with localized pancreatic cancer (PC).
METHODS: Area Deprivation Index (ADI) is a validated measure classifying neighborhood adversity. Higher ADI signifies increasing adversity. The 2013 national ADI scores were obtained from patients who completed preoperative/neoadjuvant therapy and surgery. Patients were categorized as having high (>50%) or low (≤50%) ADI.
RESULTS: Of the 224 patients, 163 (73%) had low ADI and 61 (27%) had high ADI. Adjuvant therapy was delivered to 129 (58%) patients, including 62% (101/163) with low ADI and 46% (28/61) with high ADI (p = 0.03). Patients with high ADI had 55% (95%CI 0.23-0.86; p = 0.02) decreased odds of receiving adjuvant therapy, independent of other factors. The median OS was 45 months for 129 patients who received adjuvant therapy and 31 months for 94 patients who did not receive adjuvant therapy (p = 0.03).
CONCLUSIONS: Patients with high ADI are less likely to receive adjuvant therapy for localized PC. Future studies should address impediments to care in patients from higher ADI neighborhoods.
Author List
Mora J, Krepline AN, Aldakkak M, Christians KK, George B, Hall WA, Erickson BA, Kulkarni N, Evans DB, Tsai SAuthors
Kathleen K. Christians MD Professor in the Surgery department at Medical College of WisconsinBeth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Professor in the Medicine department at Medical College of Wisconsin
William Adrian Hall MD Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin
Naveen Kulkarni MD Associate Professor in the Radiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Chemoradiotherapy, Adjuvant
Chemotherapy, Adjuvant
Female
Healthcare Disparities
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoadjuvant Therapy
Pancreatectomy
Pancreatic Neoplasms
Prospective Studies
Residence Characteristics
Retrospective Studies
Risk Factors
Socioeconomic Factors
Vulnerable Populations
