Implications of the interaction between travel burden and area deprivation for patients with pancreatic cancer

Introduction: Fragmentation of care and distance traveled are classically surrogates for poor access to care, but little is known about how social determinants of health interact with travel burden to affect survival for patients with pancreatic cancer (PC). We sought to characterize the individual and composite impact of these factors. Methods: 20769 patients treated for PC between 2005 and 2019 in the Texas Cancer Registry were included. The Area Deprivation Index and Poverty Index were used to quantify social determinants of health. Survival analyses were performed at 2 years as well as subgroup analysis on patients with the greatest travel burden. Results: Improved survival was associated with FC (HR 0.74, CI 0.71–0.77) and distance from an accredited cancer center (Quartile 4 HR 0.90, CI 0.81–1.00). High ADI led to worse outcomes while low ADI led to improved outcomes with increasing travel burden. Conclusions: This data shows a complex relationship between travel burden and survival for patients with pancreatic cancer where stratifying by area deprivation reveals divergent outcomes and the potential to exacerbate disparities.