The impact of neighborhood socioeconomic deprivation on overall survival for patients with metastatic pancreatic cancer: An incidence-based retrospective cohort study.

e16340 Background: Studies have demonstrated that metastatic pancreatic cancer patients are undertreated in the United States, which leads to worse overall survival (OS). However, these studies have typically used large geographic areas (zip codes or counties) for assessment of socioeconomic deprivation (SED). Using a statewide cancer registry, SED at the neighborhood level was used to assess receipt of treatment and OS for metastatic pancreatic cancer patients. Methods: Using the incidence-based Florida Cancer Data System, pancreatic adenocarcinoma patients diagnosed from 2007-2015were identified. The predictor variable was the Area Deprivation Index (ADI), a composite measure of SED and validated dataset that ranks neighborhoods (census block groups) from 1-100 (higher scores = higher deprivation) at the national level. Demographic, tumor, and treatment variables were assessed. Descriptive statistics and survival analysis with Kaplan-Meier curves and the log-rank test were used. Results: Overall, 9,747 patients met inclusion criteria; 53.9% were male and the median age was 70 (range 19-102). When assessed by SED quartile, there were significant differences by age, gender, race, ethnicity, insurance, and receipt of chemotherapy (p < 0.05). For the cohort, 46.5% of patients received chemotherapy. However, 54% of the lowest SED cohort received chemotherapy compared to 39.4% of the highest SED cohort (p < 0.001). The 30- and 90-day mortality was 21.7% and 50.1%, respectively. For the lowest SED quartile, 30- and 90-day mortality were 18.5% and 43.4%, respectively, compared to the highest SED quartile rate of 25.1% and 56.2%, respectively (p < 0.001 for both). Median OS was 2.9 months. The median OS for the lowest and highest SED quartiles was 3.8 and 2.4 months, respectively (p < 0.001). For patients who received chemotherapy, median OS was 6.3 months. The median OS of the lowest and highest SED quartiles for those who received chemotherapy was 7.2 and 5.9 months, respectively (p < 0.001). Conclusions: In an incidence-based, statewide cancer registry, the median OS for metastatic pancreatic cancer patients remains poor (2.9 months) and most patients do not receive chemotherapy. Additionally, higher SED patients had worse survival than lower SED patients at several time points. These data suggest that SED impacts OS and future studies are needed to understand the multilevel factors, including cancer care coordination, that lead to survival disparities in metastatic pancreatic cancer. [Table: see text]