Geospatial variation in the treatment of medicare beneficiary pancreatic cancer patients: A SEER-Medicare cohort study.

BACKGROUND

Surgical resection remains the only curative treatment for pancreatic ductal adenocarcinoma (PDAC), yet disparities in access persist.

METHODS

Using SEER-Medicare data (2011-2018), we examined variation in access to curative-intent surgery for stage I-III PDAC attributable to regional versus patient-level factors. Surgery was defined as pancreatectomy within 1-year post-diagnosis.

RESULTS

Among 9180 patients, 40.1 ​% received surgery. Lower odds of surgery were associated with older age, lower socioeconomic status, Black and American Indian/Alaskan native race, rural residence, T2 tumors, and comorbidity score of >2. Adjusted surgery rates varied from 22.0 ​% to 50.4 ​% among 120 Health Service Areas (HSAs). Using hierarchical multivariable logistic regression, 43.0 ​% of the variance in receiving surgery was attributed to unmeasured factors, 37.5 ​% to randomness, 13.2 ​% to patient-level factors, and 6.3 ​% to HSAs.

CONCLUSION

Access to curative-intent surgery for PDAC varies widely and it is largely driven by unmeasured factors rather than patient or regional factors.