Association between social determinants of health and delayed postoperative adjuvant therapy among patients undergoing resection of pancreatic cancer.
PDAC
SVI
adjuvant chemotherapy
social determinants
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
27 Dec 2023
27 Dec 2023
Historique:
received:
01
12
2023
accepted:
07
12
2023
medline:
28
12
2023
pubmed:
28
12
2023
entrez:
28
12
2023
Statut:
aheadofprint
Résumé
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. 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. 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). Most of the disparities in receipt of aCT after PDAC surgery are driven by underlying SDOH such as SVI.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
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
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
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
CONCLUSIONS
Most of the disparities in receipt of aCT after PDAC surgery are driven by underlying SDOH such as SVI.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Nipp R, Tramontano AC, Kong CY, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7(2):525-535. doi:10.1002/cam4.1277
Lima HA, Alaimo L, Moazzam Z, et al. Disparities in NCCN guideline-compliant care for patients with early-stage pancreatic adenocarcinoma at minority-serving versus non-minority-serving hospitals. Ann Surg Oncol. 2023;30(7):4363-4372. doi:10.1245/s10434-023-13230-y
Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379(25):2395-2406. doi:10.1056/NEJMoa1809775
Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369(18):1691-1703. doi:10.1056/NEJMoa1304369
Cerullo M, Gani F, Chen SY, et al. Assessing the financial burden associated with treatment options for resectable pancreatic cancer. Ann Surg. 2018;267(3):544-551. doi:10.1097/SLA.0000000000002069
Groot VP, Rezaee N, Wu W, et al. Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2018;267(5):936-945. doi:10.1097/SLA.0000000000002234
Hamad A, DePuccio M, Reames BN, et al. Disparities in stage-specific guideline-concordant cancer-directed treatment for patients with pancreatic adenocarcinoma. J Gastrointest Surg. 2021;25(11):2889-2901. doi:10.1007/s11605-021-04984-5
Bagante F, Gani F, Beal EW, et al. Prognosis and adherence with The National Comprehensive Cancer Network Guidelines of Patients with Biliary Tract Cancers: an analysis of The National Cancer Database. J Gastrointest Surg. 2019;23(3):518-528. doi:10.1007/s11605-018-3912-9
Social Determinants of Health. Accessed November 16, 2023. 2008. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Ramirez LKB, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health: (540452013-001). APA PsycNet; 2008. doi:10.1037/e540452013-001
Diaz A, Hyer JM, Tsilimigras D, Pawlik TM. The impact of social vulnerability subthemes on postoperative outcomes differs by racial/ethnic minority status. Am J Surg. 2022;223(2):353-359. doi:10.1016/j.amjsurg.2021.05.014
Hyer MJ, Tsilimigras DI, Diaz A, et al. High social vulnerability and “textbook outcomes” after cancer operation. J Am Coll Surg. 2021;232(4):351-359. doi:10.1016/j.jamcollsurg.2020.11.024
Paro A, Hyer JM, Diaz A, Tsilimigras DI, Pawlik TM. Profiles in social vulnerability: the association of social determinants of health with postoperative surgical outcomes. Surgery. 2021;170(6):1777-1784. doi:10.1016/j.surg.2021.06.001
White RJ, Hasan S, Monga D, et al. Time to adjuvant systemic therapy following pancreatic cancer resection and effect on outcome. Pancreas. 2019;48(8):1086-1091. doi:10.1097/MPA.0000000000001373
Murakami Y, Uemura K, Sudo T, et al. Early initiation of adjuvant chemotherapy improves survival of patients with pancreatic carcinoma after surgical resection. Cancer Chemother Pharmacol. 2013;71(2):419-429. doi:10.1007/s00280-012-2029-1
Bakens MJ, van der Geest LG, van Putten M, et al. The use of adjuvant chemotherapy for pancreatic cancer varies widely between hospitals: a nationwide population-based analysis. Cancer Med. 2016;5(10):2825-2831. doi:10.1002/cam4.921
Wu W, He J, Cameron JL, et al. The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol. 2014;21(9):2873-2881. doi:10.1245/s10434-014-3722-6
Turner MC, Masoud SJ, Cerullo M, et al. Improved overall survival is still observed in patients receiving delayed adjuvant chemotherapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. HPB. 2020;22(11):1542-1548. doi:10.1016/j.hpb.2020.03.006
Abraham A, Al-Refaie WB, Parsons HM, Dudeja V, Vickers SM, Habermann EB. Disparities in pancreas cancer care. Ann Surg Oncol. 2013;20(6):2078-2087. doi:10.1245/s10434-012-2843-z
CDC/ATSDR Social Vulnerability Index (SVI); 2023. Accessed October 23, 2023. https://www.atsdr.cdc.gov
Diaz A, Dalmacy D, Hyer JM, Tsilimigras D, Pawlik TM. Intersection of social vulnerability and residential diversity: postoperative outcomes following resection of lung and colon cancer. J Surg Oncol. 2021;124(5):886-893. doi:10.1002/jso.26588
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130-1139. doi:10.1097/01.mlr.0000182534.19832.83
Quan H, Li B, Couris CM, et al. Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676-682. doi:10.1093/aje/kwq433
Flanagin A, Frey T, Christiansen SL, AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA. 2021;326(7):621-627. doi:10.1001/jama.2021.13304
Leapfrog Report on Safe Surgical; 2020:9. Accessed September 23, 2023. https://www.leapfroggroup.org/
Heidsma CM, Hyer M, Tsilimigras DI, et al. Incidence and impact of textbook outcome among patients undergoing resection of pancreatic neuroendocrine tumors: results of the US neuroendocrine tumor study group. J Surg Oncol. 2020;121(8):1201-1208. doi:10.1002/jso.25900
Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32(7):700-715.
Mirkin KA, Greenleaf EK, Hollenbeak CS, Wong J. Time to the initiation of adjuvant chemotherapy does not impact survival in patients with resected pancreatic cancer. Cancer. 2016;122(19):2979-2987. doi:10.1002/cncr.30163
Munir MM, Woldesenbet S, Alaimo L, et al. Mediators of county-level racial and economic privilege in cancer screening. J Surg Oncol. 2023;127(7):1212-1222. doi:10.1002/jso.27238
Gunzler D, Chen T, Wu P, Zhang H. Introduction to mediation analysis with structural equation modeling. Shanghai Arch Psychiatry. 2013;25(6):390-394. doi:10.3969/j.issn.1002-0829.2013.06.009
Rahib L, Wehner MR, Matrisian LM, Nead KT. Estimated projection of US cancer incidence and death to 2040. JAMA Netw Open. 2021;4(4):e214708. doi:10.1001/jamanetworkopen.2021.4708
Bengtsson A, Andersson R, Ansari D. The actual 5-year survivors of pancreatic ductal adenocarcinoma based on real-world data. Sci Rep. 2020;10(1):16425. doi:10.1038/s41598-020-73525-y
Nakagawa K, Akahori T, Nishiwada S, et al. Prognostic factors for actual long-term survival in the era of multidisciplinary treatment for pancreatic ductal adenocarcinoma. Langenbecks Arch Surg. 2018;403(6):693-700. doi:10.1007/s00423-018-1709-7
Hyer JM, Tsilimigras DI, Diaz A, Dalmacy D, Paro A, Pawlik TM. Patient social vulnerability and hospital community Racial/Ethnic integration: do all patients undergoing pancreatectomy receive the same care across hospitals? Ann Surg. 2021;274(3):508-515. doi:10.1097/SLA.0000000000004989
Labiner HE, Hyer M, Cloyd JM, et al. Social vulnerability subtheme analysis improves perioperative risk stratification in hepatopancreatic surgery. J Gastrointest Surg. 2022;26(6):1171-1177. doi:10.1007/s11605-022-05245-9
Azap RA, Diaz A, Hyer JM, et al. Impact of Race/Ethnicity and county-level vulnerability on receipt of surgery among older medicare beneficiaries with the diagnosis of early pancreatic cancer. Ann Surg Oncol. 2021;28(11):6309-6316. doi:10.1245/s10434-021-09911-1
Azap RA, Hyer JM, Diaz A, Tsilimigras DI, Mirdad RS, Pawlik TM. Sex-based differences in time to surgical care among pancreatic cancer patients: a national study of Medicare beneficiaries. J Surg Oncol. 2021;123(1):236-244. doi:10.1002/jso.26266
Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350(12):1200-1210. doi:10.1056/NEJMoa032295
Klein M, Azaquoun N, Jensen BV, Gögenur I. Improved survival with early adjuvant chemotherapy after colonic resection for stage III colonic cancer: a nationwide study. J Surg Oncol. 2015;112(5):538-543. doi:10.1002/jso.24017
Wasserman DW, Boulos M, Hopman WM, Booth CM, Goodwin R, Biagi JJ. Reasons for delay in time to initiation of adjuvant chemotherapy for colon cancer. J Oncol Pract. 2015;11(1):e28-e35. doi:10.1200/JOP.2014.001531
Biagi JJ, Raphael MJ, Mackillop WJ, Kong W, King WD, Booth CM. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA. 2011;305(22):2335-2342. doi:10.1001/jama.2011.749
Bos ACRK, van Erning FN, van Gestel YRBM, et al. Timing of adjuvant chemotherapy and its relation to survival among patients with stage III colon cancer. Eur J Cancer. 2015;51(17):2553-2561. doi:10.1016/j.ejca.2015.08.016
Elkrief A, Redstone G, Petruccelli L, et al. Reasons for delay in timely administration of adjuvant chemotherapy for patients with stage III colon cancer: a multicentre cohort study from the McGill University Department of Oncology. BMJ Open Qual. 2021;10(1):e000934. doi:10.1136/bmjoq-2020-000934
Paredes AZ, Hyer JM, Palmer E, Lustberg MB, Pawlik TM. Racial/Ethnic disparities in hospice utilization among Medicare beneficiaries dying from pancreatic cancer. J Gastrointest Surg. 2021;25(1):155-161. doi:10.1007/s11605-020-04568-9
Wright MJ, Overton HN, Teinor JA, et al. Disparities in the use of chemotherapy in patients with resected pancreatic ductal adenocarcinoma. J Gastrointest Surg. 2020;24(7):1590-1596. doi:10.1007/s11605-019-04311-z
Zhu F, Wang H, Ashamalla H. Racial and socioeconomic disparities in the treatments and outcomes of pancreatic cancer among different treatment facility types. Pancreas. 2020;49(10):1355-1363. doi:10.1097/MPA.0000000000001688
Dalmacy D, Paro A, Hyer JM, Obeng-Gyasi S, Pawlik TM. Association of county-level upward economic mobility with stage at diagnosis and receipt of treatment among patients diagnosed with pancreatic adenocarcinoma. Ann Surg. 2023;277(4):e872. doi:10.1097/SLA.0000000000005238
Noel M, Fiscella K. Disparities in pancreatic cancer treatment and outcomes. Health Equity. 2019;3:532-540. doi:10.1089/heq.2019.0057
Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS. National failure to operate on early stage pancreatic cancer. Ann Surg. 2007;246(2):173-180. doi:10.1097/SLA.0b013e3180691579
Graboyes EM, Chaiyachati KH, Sisto Gall J, et al. Addressing transportation insecurity among patients with cancer. J Natl Cancer Inst. 2022;114(12):1593-1600. doi:10.1093/jnci/djac134
Fan Q, Keene DE, Banegas MP, et al. Housing insecurity among patients with cancer. J Natl Cancer Inst. 2022;114(12):1584-1592. doi:10.1093/jnci/djac136
Cheung WY, Neville BA, Earle CC. Etiology of delays in the initiation of adjuvant chemotherapy and their impact on outcomes for stage II and III rectal cancer. Dis Colon Rectum. 2009;52(6):1054-1064. doi:10.1007/DCR.0b013e3181a51173
Kim IY, Kim BR, Kim YW. Factors affecting use and delay (≥8 weeks) of adjuvant chemotherapy after colorectal cancer surgery and the impact of chemotherapy-use and delay on oncologic outcomes. PLoS One. 2015;10(9):e0138720. doi:10.1371/journal.pone.0138720
Merkow RP, Bilimoria KY, Tomlinson JS, et al. Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Ann Surg. 2014;260(2):372-377. doi:10.1097/SLA.0000000000000378
Woldesenbet S, Munir MM, Pawlik TM. Invited commentary: mediation analysis and cancer screening, identifying areas to target to improve cancer disparities. J Surg Oncol. 2023;128(1):7-8. doi:10.1002/jso.27253
Higuera O. Management of pancreatic cancer in the elderly. World J Gastroenterol. 2016;22(2):764-775. doi:10.3748/wjg.v22.i2.764
Nathan H, Pawlik TM. Limitations of claims and registry data in surgical oncology research. Ann Surg Oncol. 2008;15(2):415-423. doi:10.1245/s10434-007-9658-3