J. Mora1, A. N. Krepline1, I. Akinola1, K. K. Christians1, C. N. Clarke1, B. George2, P. S. Ritch2, W. A. Hall3, B. A. Erickson3, K. S. Dua4, M. O. Griffin5, M. R. Holt5, D. B. Evans1, S. Tsai1 1Medical College Of Wisconsin,Division Of Surgical Oncology,Milwaukee, WI, USA 2Medical College Of Wisconsin,Division Of Hematology And Oncology,Milwaukee, WI, USA 3Medical College Of Wisconsin,Department Of Radiation Oncology,Milwaukee, WI, USA 4Medical College Of Wisconsin,Division Of Gastroenterology And Hepatology,Milwaukee, WI, USA 5Medical College Of Wisconsin,Department Of Radiology,Milwaukee, WI, USA
Introduction: Area of deprivation index (ADI) is a geographic-based measurement of socioeconomic deprivation and has been used to study the relationship between social determinants and healthcare quality and outcomes. The impact of ADI on the delivery of postoperative (adjuvant) therapy to patients with pancreatic cancer (PC) is unknown.
Methods: Patients with localized PC who completed all neoadjuvant therapy and surgery were identified from a prospective database at the Medical College of Wisconsin. ADI for all patients was obtained using the ZIP code+4 code. Patients were dichotomized into high and low ADI categories based on the median ADI. Clinicopathologic data, preoperative (neoadjuvant) therapy, surgical outcomes, and the receipt of adjuvant therapy were abstracted.
Results: From 2009-2018, 310 patients with localized, operable PC who completed all neoadjuvant therapy and surgery were identified. If data regarding adjuvant therapy was missing (n=12), these patients were excluded. Of the remaining 298 patients, the median ADI was 97.50 (IQR 17.3); 149 (50%) patients in the high and low ADI groups. There was no difference between groups in age, gender, clinical stage, carbohydrate antigen 19-9 at diagnosis, type of neoadjuvant therapy, or type of operation performed. Pancreaticoduodenectomy was the most common operation performed (n=238; 80%). Grade 3 or higher Clavien complications occurred in 39 (13%) of the 298 patients; 19 (49%) in the low ADI group and 20 (51%) in the high ADI group (p=0.86). Adjuvant therapy was received by 167 (56%) of the 298 patients; 95 (64%) of the 149 patients with low ADI and 72 (48%) of the 149 patients with high ADI (p =0.007). In a multivariable logistic regression, high ADI was associated with a 54% decreased odds of receiving any adjuvant therapy (95% CI:0.27-0.79, p=0.005). Age >65, neoadjuvant therapy consisting of chemotherapy and chemoradiation, and postoperative Grade 3+ complications were also independently associated with decreased odds of receiving adjuvant therapy (Table 1).
Conclusion: Following neoadjuvant therapy and surgery, 56% of patients received any adjuvant therapy. Patients from high ADI neighborhoods were significantly less likely to receive adjuvant therapy independent of other well described risk factors including older age, previous multimodality neoadjuvant therapy, and Grade 3+ postoperative complications. Future studies should examine the challenges to delivery care in high ADI neighborhoods.
