Society for Surgery of the Alimentary Tract
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Sheena Bhushan*, Tanya Aggarwal, Oluseyi Abidoye, Zainab Abbasi, Aditya Ghosh, Shane Robinson, Nelson A. Royall, Louise Jones
Internal Medicine, Northeast Georgia Health System Inc, Gainesville, GA

Pancreatic adenocarcinoma is a deadly cancer with 5-year survival rates < 10%. Only 20% of patients are eligible for surgical resection, but 5-year survival rates of these patients doubles to 25%. Prior studies have suggested more favorable surgical resection outcomes at high-volume hospitals. Subsequently, the centralization of pancreatic resection to high-volume centers has been proposed by several authors. However, rural communities across the United States have limited access to centralized care due to a multitude of reasons, including insurance, travel time, awareness, and ease. Prior studies show poorer survival rates among pancreatic cancer patients in rural areas than their urban counterparts. To our knowledge, no such studies have been conducted in rural northeast Georgia. The purpose of this study was to study treatment utilization and mortality trends among pancreatic cancer patients at a large safety net hospital in rural Northeast Georgia.

Using our hospital's cancer registry, we observed newly diagnosed pancreatic ductal adenocarcinoma from January 2017-July 2022. Data, including patient demographics, tumor lymph node metastasis (TNM) classification, treatment, and survival, were collected and analyzed using Chi-square for the categorical variables. Binomial logistic regression was performed to ascertain the effects of patient demographic characteristics, age at diagnosis, and treatment or therapeutic modalities on the likelihood that participants died.

Of the 314 individuals in this study, 54.8% (n=172) were male, and 45.2% (n=142) were female, with a mean age of 69.9 (SD=10.7). At the time of death, the mean age was 71.6 (SD = 9.9) years. There was a statistically significant association between mortality and being treated with palliative care (χ2(1) = 15.3249, p < .001) as well as between cancer staging (χ2(6) = 12.589, p = .050). The logistic regression model was statistically significant, χ2(16) = 44.848, p <.001. The model explained 18.0% (Nagelkerke R2) of the variance in mortality. Increasing age was associated with higher odds of mortality (p=0.003). Palliative care had 3.039 times higher odds of mortality (p=0.007), and surgical resection had 4.999 times higher odds of mortality(p=0.010).

Mortality was lowest for stage 1A and markedly increased for stage IV. Higher mortality was noted in patients who received palliative chemotherapy which we infer could be due to late presentation and late diagnosis. Patients who underwent surgical resection at a tertiary institution had ~5 times higher odds of mortality. We infer this could be due to a lack of timely access to a centralized high-volume center. While our study is limited by its small sample size, these findings warrant a large-scale study across rural communities in the United States to understand these trends more accurately.

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