The Relationship Between Race, Social Vulnerability Index, and Clinical Follow-Up After Surgical Resection of Pituitary Tumors

Abstract

IntroductionSocioeconomic status and race have been found to influence patient outcomes for various cancer subtypes. In particular, minority and economically vulnerable patients present with more advanced disease and experience decreased survival compared to others. The aim of this study was to analyze the association between demographic or socioeconomic variables and rates of post-surgical follow-up after pituitary neuroendocrine tumor (PitNET) resection. MethodsA retrospective review was completed for patients with PitNETs who underwent surgery between 2018-2021. Patient demographics and information related to post-operative appointments and MRIs were obtained. Social vulnerability index (SVI) scores were recorded from the Centers for Disease Control based on nationwide census tracts. ResultsOne-hundred and sixteen patients were included in the analysis (57 males). In this cohort, 50% were Black, 34% Hispanic, 9% White, and 1% Asian. Mean overall SVI score was 0.81±0.23. The mean number of cancelled appointments was significantly higher in the moderate-high/high SVI group (p=0.034). Additionally, 30% of patients with moderate-high/high SVI had ≥2 cancelled follow-up visits compared to 0% among patients with low/low-moderate SVI (p=0.035). On average, White patients were less likely than non-White patients to have at least one cancelled follow-up appointment (p=0.048). ConclusionBlack patients and those with high social vulnerability have decreased rates of follow-up after PitNET resection. Follow-up delays can lead to failed identification of tumor recurrence, potentially resulting in more advanced disease by the time medical care is re-initiated and increasing rates of patient morbidity and mortality. As a result, further work is needed to address and bridge these care gaps.