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Association between Rural Residence and Processes of Care in Pancreatic Cancer Treatment

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Pancreatic adenocarcinoma (PDAC) is an aggressive malignancy associated with poor outcomes. Surgical resection and receipt of multimodal therapy have been shown to improve outcomes in patients with potentially resectable PDAC; however treatment and outcome disparities persist on many fronts. The aim of this study was to analyze the relationship between rural residence and receipt of quality cancer care in patients diagnosed with non-metastatic PDAC.

Methods

Using the National Cancer Database, patients with non-metastatic pancreatic cancer were identified from 2006–2016. Patients were classified as living in metropolitan, urban, or rural areas. Multivariable logistic regression was used to identify predictors of cancer treatment and survival.

Results

A total of 41,786 patients were identified: 81.6% metropolitan, 16.2% urban, and 2.2% rural. Rural residing patients were less likely to receive curative-intent surgery (p = 0.037) and multimodal therapy (p < 0.001) compared to their metropolitan and urban counterparts. On logistic regression analysis, rural residence was independently associated with decreased surgical resection [OR 0.82; CI 95% 0.69–0.99; p = 0.039] and multimodal therapy [OR 0.70; CI 95% 0.38–0.97; p = 0.047]. Rural residence independently predicted decreased overall survival [OR 1.64; CI 95% 1.45–1.93; p < 0.001] for all patients that were analyzed. In the cohort of patients who underwent surgical resection, rural residence did not independently predict overall survival [OR 0.97; CI 95% 0.85–1.11; p = 0.652].

Conclusions

Rural residence impacts receipt of optimal cancer care in patients with non-metastatic PDAC but does not predict overall survival in patients who receive curative-intent treatment.

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Data Availability

The National Cancer Database is available through the American College of Surgeons.

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Authors and Affiliations

  1. Department of Surgery, The University of South Alabama, 2451 USA Medical Center Drive, Mastin, 705, Mobile, AL, 36617, USA

    Krisha Amin, Victoria Prete, Martin J. Heslin & Annabelle L. Fonseca

  2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Hamza Khan

  3. Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, AL, USA

    Larry R. Hearld

  4. Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA

    Daniel I. Chu

  5. Department of Psychology, The University of South Alabama, Mobile, AL, USA

    Krista R. Mehari

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Contributions

KA, AF were involved in data acquisition and analysis, KA, HK, LH, DC, KM, MH and AF were involved in conceptualization, design and methodology. KA, HK, LH, DC, VC, KM, MH, and AF were involved in manuscript preparation, edition, and revision.

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Correspondence to Annabelle L. Fonseca.

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Amin, K., Khan, H., Hearld, L.R. et al. Association between Rural Residence and Processes of Care in Pancreatic Cancer Treatment. J Gastrointest Surg 27, 2155–2165 (2023). https://doi.org/10.1007/s11605-023-05764-z

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