A population-based analysis of urban–rural disparities in advanced pancreatic cancer management and outcomes

Abstract

Given the significant morbidity burden associated with advanced pancreatic cancer (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. Patients diagnosed with APC from 2008 to 2015 and received Gemcitabine (Gem), Gemcitabine 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 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. In total, we identified 659 patients: median age 68 years, 54.3% men, and 76.6% metastatic disease. For treatment, 67.7, 9.2, and 23.0% 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 31.5 and 29.5 days for rural patients and 28.6 and 40.1 days for urban patients, respectively (all p > 0.05). Use of Gem/Nab (10.1% vs 9.1%) and FOLFIRINOX (21.0% vs 23.5%) were similar regardless of rurality. In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 0.864, 95% CI 0.619-1.206, p = 0.09). 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.

Impact of Geography on Care Delivery and Survival for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

“…A geographic analysis of advanced pancreatic cancer found no difference in survival between rural and urban residence, albeit within a sample of patients who had already received chemotherapy, with some having undergone curative-intent resection. 53 A different study of unresected pancreatic cancer indicated that rural living negatively impacted oncology consultation but not receipt of chemotherapy. 54 A similar pattern was also observed for radiation therapy delivery, whereby greater distance was inversely associated with radiation oncology consultation but not with receipt of therapy.…”

Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: a population-based analysis

“…Previous studies have most commonly addressed acceptability of therapy by focusing on patients receiving chemotherapy and describing the use of different regi mens. 14,[30][31][32] Some small studies that examined referral patterns were limited by smaller sample sizes or also encompassed cura tive management, which confused the results. 11,12 Rates of medi cal oncology consultations for noncurative pancreatic adenocar cinoma have been reported at 31% in Nova Scotia and 54% in Alberta, with older age and higher comorbidity burden associ ated with no consultation.…”

Rural‐Urban Disparities in Pancreatic Cancer Stage of Diagnosis: Understanding the Interaction With Medically Underserved Areas

“…Several studies have highlighted that rural pancreatic cancer patients tend to experience worse survival rates even after controlling for a number of patient factors 7,12‐15 . The 2 exceptions that show limited differences in survival by rurality are based outside of the United States, 16,17 where the different health care systems may explain the lack of disparities. One potential factor that could be contributing to worse survival outcomes in rural patients is later stage of diagnosis, the focus of the current study.…”