A population-based analysis of urban-rural disparities in advanced pancreatic cancer (APC) management and outcomes.

Abstract

254 Background: Given the significant morbidity burden associated with APC, its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Methods: Patients diagnosed with APC (locally advanced or metastatic disease) from 2008 to 2015 and received gemcitabine (gem), gem plus nab-paclitaxel (gem/nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers across the province were reviewed. Using postal codes, the Google Maps Distance Matrix determined the distance from each patient’s residence to the closest cancer center. Rural and urban status were defined as patients living >= 100 km and < 100 km from the closest treatment site, respectively. Univariate and Cox regression analyses were applied to examine whether rurality resulted in variations in management and outcomes. Results: In total, we identified 667 patients: median age 68 years, 54.3% men, and 45.7% metastatic disease. Among them, 19.5% lived rurally and 80.5% resided in urban areas. For treatment, 67.8%, 9.4%, and 22.8% received gem, gem/nab, and FOLFIRINOX, respectively. However, there were no differences in baseline clinical characteristics between rural and urban patients (all p > 0.05). Also, there were no significant variations in treatment patterns. For example, time from diagnosis to oncology appointment and time from appointment to treatment were 31.6 and 29.5 days for rural patients and 28.7 and 39.9 days for urban patients, respectively (all p > 0.05). Use of gem/nab (9.8 vs 9.4%) and FOLFIRINOX (20.5 vs 23.3%) were similar regardless of rurality. In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 1.34, 95% CI 0.95-1.87, p = 0.09). Conclusions: Our findings suggest that there is no correlation between rurality and outcomes in APC. The strategic and geographic allocation of cancer care delivery across the province of British Columbia may serve as a model for other jurisdictions that experience disparities in the outcomes of cancers that often require complex multidisciplinary care.