Association between social determinants of health and delayed postoperative adjuvant therapy among patients undergoing resection of pancreatic cancer
Zayed Rashid, Muhammad M. Munir, Selamawit Woldesenbet, Muhammad M. M. Khan, Mujtaba Khalil, Yutaka Endo, Diamantis I. Tsilimigras, Mary Dillhoff, Aslam Ejaz, Timothy M. Pawlik- Oncology
- General Medicine
- Surgery
Abstract
Background and Objectives
Pancreatic cancer (PDAC) requires a multimodality approach. We sought to define the association between social determinants of health (SDOH) and delayed or nonreceipt of adjuvant chemotherapy (aCT) among patients undergoing PDAC resection.
Methods
Data on patients who underwent PDAC resection between 2014 and 2020 were identified from Medicare Standard Analytic Files and merged with the county‐level social vulnerability index (SVI). Mediation analysis defined the association between SVI subthemes and aCT receipt.
Results
Among 24 078 patients, 47.7% received timely aCT, 17.7% received delayed aCT, and 34.6% did not receive any aCT. High SVI was associated with delay (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.10–1.34) and nonreceipt of aCT (OR 1.30, 95% CI 1.20–1.41) (both p < 0.05). 73.1% of the variation in timely aCT receipt was directly attributable to SVI, whereas 26.9% of the effect was due to indirect mediators including hospital volume (6.4%), length‐of‐stay (7.9%) and postoperative complications (12.6%). Socioeconomic status (delayed aCT: OR 1.25, 95% CI 1.13–1.38; nonreceipt aCT: OR 1.25, 95% CI 1.15–1.36) and household composition and disability (delayed aCT: OR 1.30, 95% CI 1.17–1.43; nonreceipt aCT: OR 1.19, 95% CI 1.09–1.29) were associated with receipt of aCT (both p < 0.001).
Conclusions
Most of the disparities in receipt of aCT after PDAC surgery are driven by underlying SDOH such as SVI.