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

Bertens, Kimberly A.; Massman, John D.; Helton, Scott; Garbus, Samuel; Mandelson, Margaret M.; Lin, Bruce; Picozzi, Vincent J.; Biehl, Thomas; Rocha, Flavio G.

doi:10.1002/jso.25060

Cited by 20 publications

(12 citation statements)

References 22 publications

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“…Despite the increasing attention paid to rural‐urban disparities in cancer care broadly, 11 the amount of attention focused on pancreatic cancer has been more modest. Several studies have highlighted that rural pancreatic cancer patients tend to experience worse survival rates even after controlling for a number of patient factors 7,12‐15 . The 2 exceptions that show limited differences in survival by rurality are based outside of the United States, 16,17 where the different health care systems may explain the lack of disparities.…”

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confidence: 99%

Rural‐Urban Disparities in Pancreatic Cancer Stage of Diagnosis: Understanding the Interaction With Medically Underserved Areas

Segel

Hollenbeak

Gusani

2020

The Journal of Rural Health

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Purpose To estimate differences in pancreatic cancer diagnosis stage by rurality of patient residence and residence in a medically underserved area (MUA). Methods Using 2010‐2016 Pennsylvania Cancer Registry data, we restrict our analysis to adults diagnosed with pancreatic cancer. We categorize each patient's residence by Rural‐Urban Continuum Codes (RUCC): (1) metro; (2) nonmetro adjacent with population ≥20,000; (3) nonmetro adjacent with population <20,000; (4) nonmetro nonadjacent, and (5) completely rural; also by whether the county was a full MUA, partial MUA, or non‐MUA. We examine the percent of patients diagnosed with local and locoregional stage of disease for each residential rurality and MUA status grouping. We estimate multivariate linear probability models of local and locoregional stage of diagnosis while controlling for demographics, insurance type, year, rurality, and MUA status. Finally, we estimate models interacting rurality with MUA status to disentangle the relative impact of each on diagnostic stage. Findings We find that no pancreatic patients living in completely rural areas were diagnosed at the local stage, the lowest of all categories of rurality. In adjusted models, we find that patients living in completely rural areas have significantly lower rates of local and local/regional stage of diagnosis. The estimates are attenuated slightly when controlling for MUA. Conclusions We find significantly lower rates of early stage pancreatic cancer diagnosis for patients living in completely rural areas. While lack of primary medical care resources is an important factor, rural residence remains an important independent predictor in later stage of diagnosis.

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confidence: 99%

Rural‐Urban Disparities in Pancreatic Cancer Stage of Diagnosis: Understanding the Interaction With Medically Underserved Areas

Segel

Hollenbeak

Gusani

2020

The Journal of Rural Health

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“…Screening is useful not only to generate further knowledge, but also to diagnose high-risk lesions before they become invasive [19]. Lesions that can lead to pancreatic cancer (T1N0M0 Adenocarcinoma, PanINs3a, BD- and MD-IMPN) as well as abnormalities like inflammation are detected in these specialized centers [11,26,77,94]. …”

Section: Discussionmentioning

confidence: 99%

“…After this, more centers in Japan (Kyoto University, Japanese Familial Pancreatic Cancer Registry), USA (17 centers), Canada (Mount Sinai Hospital, Toronto, Familial Gastrointestinal Cancer Registry), Europe (Germany, Italy, Spain), and Australia (The Kinghorn Cancer Center, Australian Pancreatic Cancer Genome Initiative) have been established [19]. Of course, it is important that specialized screening centers are available for all patients, especially those who have limited access to healthcare [77]. …”

Section: Procedures Of Screeningmentioning

confidence: 99%

Familial Pancreatic Cancer

Benzel

Fendrich

2018

Oncol Res Treat

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Familial pancreatic cancer accounts for 10% of all patients with pancreatic cancer. Because the 5-year survival rate of pancreatic cancer is only 7%, screening programs for high-risk individuals are essential and might be advantageous. Pancreatic ductal adenocarcinoma mostly shows symptoms at an advanced state and treatment is not efficient enough to cure most patients. People with hereditary tumor syndromes or their affected relatives can also be included in such screening programs. Besides the collection of data to investigate the background of the disease, these screening programs aim to diagnose and treat precursor lesions so that more dangerous, invasive lesions are prevented. These precursor lesions can be pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasm, and mucinous cystic neoplasm. This review summarizes the latest knowledge of pancreatic screening programs, shows the procedure of pancreatic cancer screening, and gives an overview of current guidelines.

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“…Most, but not all, common medical and surgical disorders have worse outcomes in patients from distressed communities ( Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21] DOES LIVING IN A DISTRESSED COMMUNITY CAUSE WORSE OUTCOMES FROM SURGICAL PROCEDURES? Table 1 suggests that living in a distressed community is associated with worse outcomes from many medical disorders and from surgical interventions.…”

Section: How Do You Know If You Live In a Distressed Community?mentioning

confidence: 99%

“…Kidney transplant 15 Breast cancer initial treatment 16 Lower extremity revascularization 17 Pancreatic cancer 18 CABG readmissions 19…”

Section: Urolithiasis 14mentioning

confidence: 99%

Commentary: Do you live in a distressed community? How do you know? What does this mean? What are the risks? How do you get help?

Ferraris

2020

The Journal of Thoracic and Cardiovascular Surgery

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

Abstract: URR inhabitance does not impact access to AT, however it is independently associated with a decreased OS. Attention must be focused on optimizing oncologic care to patients with disparate access to healthcare.

Cited by 20 publications

References 22 publications

Rural‐Urban Disparities in Pancreatic Cancer Stage of Diagnosis: Understanding the Interaction With Medically Underserved Areas

Rural‐Urban Disparities in Pancreatic Cancer Stage of Diagnosis: Understanding the Interaction With Medically Underserved Areas

Familial Pancreatic Cancer

Commentary: Do you live in a distressed community? How do you know? What does this mean? What are the risks? How do you get help?

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