Biology vs Barriers: The Impact of Socioeconomic Disadvantage on Overall Survival in Pancreatic Cancer Despite Guideline-Concordant Treatment

Abstract

Background: Survival in pancreatic cancer is traditionally reported to be influenced by anatomic (A), biologic (B), and comorbidity (C)-related factors. The role of socioeconomic disadvantage (D) remains unexplored. In this study, we assessed the impact of D on survival in patients receiving guideline-concordant treatment (GCT) for nonmetastatic pancreatic cancer.

Study design: A retrospective review was performed of patients with nonmetastatic pancreatic cancer treated at 2 academic centers in the South (2018 to 2022). Neighborhood socioeconomic disadvantage was measured using the Area Deprivation Index and stratified into terciles (low, medium, and high). Inverse probability weighting and multivariable Cox models were used to evaluate the impact of D as well as A, B, and C on survival.

Results: Four hundred eighty-four of 743 patients (65%) received GCT. Patients living in high deprivation areas were more likely to be Black, unmarried, have Medicaid, present through the emergency department, lack prior cancer screening, and were less likely to receive GCT (all p < 0.01). On univariable analysis, living in areas of intermediate or high disadvantage was associated with decreased survival (p < 0.001).On Cox analysis accounting for sociodemographic and cancer-specific variables (A, B, and C), as well as GCT, factors independently predictive of decreased survival included living in areas of intermediate (hazard ratio [HR] 1.4 [1.1 to 1.7], p = 0.007) or high disadvantage (HR 1.9 [1.5 to 2.4], p < 0.001), nonreceipt of GCT (HR 1.7 [1.4 to 2.0], p < 0.001), aggressive tumor biology (HR 1.4 [1.2 to 1.7], p < 0.001), and Charlson Comorbidity Index ≥ 3 (HR 1.6 [1.1 to 2.3], p = 0.004).

Conclusions: Residence in a socioeconomically disadvantaged area independently predicts decreased survival, even after adjusting for clinical factors and GCT. Our results suggest that strategies such as transportation assistance, nutritional support, and care navigation may be actionable approaches to improve survival in vulnerable patients with resectable pancreatic cancer.