The impact of neighborhood socioeconomic deprivation on pancreatic cancer stage and treatment in Florida: A statewide retrospective cohort study.

Abstract

150 Background: Increasing socioeconomic deprivation (SED) is associated with higher cancer stage at diagnosis and less treatment. However, most studies have used large geographic areas and lacked detailed staging or treatment variables. To overcome this, SED at the neighborhood (census-block group) level was used to assess pancreatic cancer stage and treatment in Florida. Methods: Using the incidence-based Florida Cancer Database, 16,319 patients diagnosed with pancreatic adenocarcinoma from 2008-2015 were identified. The Area Deprivation Index, a validated dataset that ranks census block groups (neighborhoods) from 1-100 (higher scores=higher deprivation) at the national level based on SED, was used to assess stage at diagnosis and treatment by quintile. Descriptive statistics and tests of association were used. Results: The median SED for pancreatic cancer in Florida was 57. SED was associated with stage at diagnosis (Table 1). The lowest SED patients had the lowest rate of stage IV disease (46.8%). Surgery and chemotherapy were delivered to 18% and 60% of all patients. Of stage I patients without risk factors contraindicating surgery, 29.1% received curative-intent surgery. For these patients, high SED compared to the lowest SED was associated with a lower surgery rate (25.8% vs 30.9%, respectively; p=0.006). For stage IV patients, 60.6% received chemotherapy and higher SED was associated with a lower rate of chemotherapy receipt compared to the lowest SED patients (55.8% vs. 66.7%, respectively; p=0.001). Conclusions: Neighborhood SED was associated with stage at diagnosis and receipt of pancreatic cancer treatment. Most eligible stage I pancreatic cancer patients in Florida do not receive curative-intent surgery and nearly half of stage IV patients do not receive chemotherapy. Higher SED is associated with lower rates of treatment. Research is urgently needed to characterize and overcome the failure to treat pancreatic cancer in Florida.[Table: see text]