BACKGROUND Social determinants of health impact the delivery of care and outcomes in patients with pancreatic cancer. We explored the relationship between social determinants of health and presentation, treatment, and… Click to show full abstract
BACKGROUND Social determinants of health impact the delivery of care and outcomes in patients with pancreatic cancer. We explored the relationship between social determinants of health and presentation, treatment, and outcomes of patients with pancreatic adenocarcinoma at an urban, safety-net medical center. DESIGN A single institution retrospective chart review of patients with pancreatic adenocarcinoma was conducted. Demographic, tumor, and treatment characteristics were obtained. Median overall survival, stage specific survival, receipt of curative surgery, and receipt of perioperative therapy were analyzed. Chi-squared tests were utilized for categorical variables. Survival was determined by the Kaplan-Meier method. RESULTS We identified 240 patients with pancreatic adenocarcinoma treated between January 2006 and December 2017. The median age was 66 years, 51% were female, 48% were non-white, 22% were non-English speaking, 16% were Hispanic, and 40% were Medicaid/uninsured. There were 74 patients (31%) with early stage (I/II) disease. There were no statistically significant differences between race, primary language, ethnicity, and receipt of surgical therapy or receipt of perioperative therapy. Relatively more patients with private insurance (100%) received perioperative therapy compared to Medicaid/uninsured (64%), and Medicare insured (50%) patients (p=0.018). Nearly 30% of patients with operable disease either declined having an intervention or were found to be too frail to undergo surgical intervention. CONCLUSION There were no statistically significant relationships between examined social determinants of health and utilization of surgery or perioperative therapy. Patients treated at an urban, safety-net hospital with a focus on vulnerable patient populations are able to provide outcomes similar to national averages. Further exploration of factors affecting outcomes for pancreatic cancer in these patients will be important as many centers absorb higher immigrant and indigent populations.
               
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