Association between social determinants of health and delayed postoperative adjuvant therapy among patients undergoing resection of pancreatic cancer.
J Surg Oncol
; 129(5): 850-859, 2024 Apr.
Article
em En
| MEDLINE
| ID: mdl-38151795
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Pancreáticas
/
Determinantes Sociais da Saúde
Limite:
Aged
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Surg Oncol
/
J. surg. oncol
/
Journal of surgical oncology
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos