Beyond the dollar: Influence of sociodemographic marginalization on surgical resection, adjuvant therapy, and survival in patients with pancreatic cancer

Abstract

Sociodemographic marginalization exerts its influence early in the pancreatic cancer care continuum, and appears to be associated more with which patients undergo surgical resection than the receipt of adjuvant treatment. Cancer 2016;122:3175-82. © 2016 American Cancer Society.

Initiation of adjuvant therapy following surgical resection of pancreatic ductal adenocarcinoma (PDAC): Are patients from rural, remote areas disadvantaged?

“…It is probable that a great proportion of the inequality that exists for black patients with PDAC is encountered prior to being selected for surgery. This has been shown to be true for socio‐demographic marginalization in a recent study of the single‐payer universal health care system in Ontario, Canada . Coburn et al used a provincially maintained database to demonstrate that patients with material deprivation as well as those living in rural areas had a decreased likelihood of undergoing surgical resection.…”

Population-based study of the impact of surgical and adjuvant therapy at the same or a different institution on survival of patients with pancreatic adenocarcinoma

“…Pathologic characteristics, including staging and margins status, were obtained using a previously established data set created by manual abstraction of pathology reports from the OCR. As reported previously , the standardized abstraction tool was based on the 2013 College of American Pathologists protocol and validated by independent dual abstraction of 15 per cent of the reports.…”

“…Patients with at least two billing codes within 150 days of surgery were categorized as receiving this treatment. The identification of chemotherapy administration using OHIP has been described previously with 90 per cent concordance between OHIP codes and patient medication records (ALR) , . Patients were excluded if aged less than 18 years or more than 99 years, if they had a diagnosis of another cancer before or after surgery, or if they had received neoadjuvant therapy.…”

“…Relevant demographic and clinical characteristics were identified a priori as potential confounders of the relationship between location of adjuvant chemotherapy and OS. These variables were selected based on clinical relevance (markers of complexity of cancer care) and existing literature (known relationship between pancreatic adenocarcinoma and OS) . The most parsimonious set of co‐variables was selected to maintain adequate study power.…”

Barriers to Surgical Resection of Pancreatic Adenocarcinoma

“…In Canada, with its universal healthcare system, survival for pancreas adenocarcinoma was associated with similar factors identified in this study, including age, gender, and comorbidities, as well as other factors such as urban residence with lower income, rural residence, resident instability, and material deprivation. 15 Other universal health systems, such as in Denmark, have also found similar factors associated with pancreas cancer survival, e.g. urban living.…”