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GUIDELINE CONCORDANT TREATMENT IN PANCREATIC CANCER. WHO ARE THE MOST VULNERABLE?
Ioannis Liapis
*1, Jaspinder S. Sanghera
1, Michelle Holland
1, Omar Ahmed
1, Rida Ahmad
2, Krisha Amin
2, Ahmed Abdalla
2, Smita Bhatia
1, Martin Heslin
1, Annabelle L. Fonseca
11The University of Alabama at Birmingham, Birmingham, AL; 2University of South Alabama, Mobile, AL
Background Pancreatic Adenocarcinoma is the third leading cause of cancer deaths in the US, and has a rising incidence. A substantial proportion of patients do not receive evidence-based type- and stage-specific treatment i.e. Guideline Concordant Treatment (GCT). This study aims to investigate the underlying factors influencing receipt of GCT.
Methods We performed a multi-institutional retrospective review of patients with pancreatic adenocarcinoma receiving care at 2 academic institutions in the Deep South, from 2018-2022. GCT was defined based on National Comprehensive Cancer Network guidelines. Descriptive statistics and logistic regression analyses were performed to identify predictors of GCT. A multivariable logistic regression model was developed using purposeful selection to adjust for potential confounders.
Results Of the 951 patients, 72% received GCT. The majority of patients were white (72%), insured through Medicare (53%), and had a primary care provider (77%). Factors independently predictive of non-receipt of GCT included age ?75 years old (adjOR 0.37, p=0.006), Medicare insurance (adjOR 0.58, p=0.004), no prior cancer screening (adjOR 0.62, p=0.006), living in an area of high deprivation (adjOR 0.68, p=0.081), and ECOG performance status ? 2 (adjOR = 0.60, p=0.019). Conversely, male gender (adjOR 1.35, p=0.074), and higher albumin levels – proxy to better nutritional status – (adjOR 1.64, p<0.001) were associated with increased receipt of GCT (Table 1).
Conclusion Significant disparities exist in the receipt of GCT among patients with pancreatic cancer. Older age, Medicare insurance (versus private), high area deprivation, and lack of prior cancer screening are associated with decreased receipt of GCT, while better nutritional status and male gender predict GCT. Identifying patients at risk for non-GCT early and developing targeted strategies to address underlying barriers- such as improving nutritional support- are essential to improve the delivery of GCT.
Table1. Univariate and Multivariate Logistic Regression Analyses for the Outcome of Receiving GCT
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