From disadvantage to advantage: closing the care gap in tertiary health care for vulnerable groups

Document Type

Conference Proceeding

Publication Date

1-1-2025

Publication Title

HPB (Oxford)

Abstract

Background: Lower socioeconomic status (SES) has consistently been linked to worse cancer outcomes, including higher mortality rates and lower survival probabilities. The Area Deprivation Index (ADI), a validated measure of neighborhood-level SES, captures these socioeconomic disparities and gives us a better understanding of how social determinants of health impact cancer care and outcomes. Our Multidisciplinary Pancreas Clinic – comprising nurse navigation, medical, surgical, radiation oncologists, psychologists, and nutritionists – aims to provide equitable and efficient care to all patient demographics in our integrated health system. We sought to explore the association between neighborhood disadvantage and time between initial diagnosis and first consultation in patients diagnosed with Pancreatic Ductal Adenocarcinoma (PDAC) as well as clinical tumor staging at diagnosis. Methods: A retrospective analysis of PDAC patients diagnosed between 2016 and 2024 was conducted. To measure neighborhood disadvantage, the cohort was categorized into ADI quartiles: Q1 (1-25), Q2 (26-50), Q3 (51-75) and Q4 (76-100) with 1 and 100 being the least and most disadvantaged groups, respectively. Associations between ADI and time to first consultation (in days) and clinical tumor staging (categorized into localized (Stages I&II) and advanced (Stages III&IV) were studied using Logistic and Linear Regression Models. Results: 551 patients were diagnosed with PDAC between 2016 and 2024. 43 patients had an ADI in Q1 (7.8%), 120 in Q2 (21.8%), 176 in Q3 (31.9%) and 212 in Q4 (38.5%). The mean age at diagnosis was 67.7 ± 10.2, the median ADI was 65, and the mean time to first consultation was 10.4 ± 6.3 days. 293 patients had localized disease at diagnosis (53.2%), while 258 had advanced disease (46.8%). In our institution, there was no significance in the time from diagnosis to consultation across the four quartiles of ADI. When evaluating ADI and its association with clinical stage at presentation, patients in Q4 (Adjusted OR: 0.51, 95% CI [0.26;0.98], p-value= 0.04) were less likely to present with advanced tumors when compared to those in Q1. Specifically, patients in Q1, Q2, Q3 and Q4 presented with stage IV disease in 34.9%, 28.3%, 25.0% and 22.2% respectively. Conclusion: Our data suggest that a dedicated multidisciplinary pancreas clinic in an integrated health care system can provide equitable access to care for patients newly diagnosed with PDAC. There was no difference in the time to first consultation, with results showing similar times for all ADI ranges and no statistical significance between the quartiles. These results highlight both the dedication of the healthcare team to provide equitable access to patients of all social determinants of health. Interestingly, we identified that patients who came from more disadvantaged neighborhoods (Q4) presented at earlier stages than those in Q1. Further analysis will be performed to assess such associations over time.

Volume

27

First Page

S127

Last Page

S128

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