The impact of lower household income and distance to hospital on treatment and survival in patients with localized pancreatic adenocarcinoma.

INTRODUCTION

Socialdeprivation, which is exaggerated by lower household income, shortens life expectancy and worsens cancer survival. In pancreatic adenocarcinoma, novel treatment strategies aim to extend survival and centralization of care has increased distance to hospital. The effect of distance to hospital and different treatment regimens on survival stratified by household income remains unexplored.

METHODS

A nationwide retrospective study using Netherlands Cancer Registry data (2017-2022) included patients with localized pancreatic adenocarcinoma. Patients were categorized into three groups based on household income (lowest, intermediate and highest income) and two distance groups based on median distance to hospital. Multivariable logistic and Cox regression analyses assessed the effect of lower household income and distance on treatment and survival. Kaplan-Meier curves were used for univariable survival analysis.

RESULTS

Among 5926 patients, individuals from lower household income received less anti-cancer treatment (44% lowest vs. 63% highest, P < 0.001). Living within 14 km increased the likelihood of resection (Odds ratio (OR) 1.44, 95%CI 1.28-1.63, P < 0.001) and adjuvant chemotherapy (OR 1.29, 95%CI 1.18-1.71, P < 0.001). Median survival was 7 months (lowest income), 9 months (intermediate), and 11 months (highest income) (P < 0.001). In the multivariable analysis, worse survival in the lowest income group persisted after case-mix adjustment (HR (highest vs lowest): 0.92, 95% CI 0.86-0.98, P < 0.001). However, after additional adjustment for treatment differences, survival differences between income groups disappeared (P = 0.180).

CONCLUSION

Lower household income negatively impacts the likelihood of receiving treatment for patients with pancreatic adenocarcinoma. Additionally, distance to hospital is negatively associated with the probability of receiving resection and subsequent treatment.