Abstract C048: Socioeconomic and clinical determinants of timely supportive care medication use in pancreatic cancer: A national cohort study

Abstract Background: Pancreatic cancer (PC) is associated with significant symptom burden, making timely initiation of supportive care medications (SCMs) a critical component of effective management. While prior research has shown differences in SCM use by socioeconomic status (SES), particularly lower use among patients from disadvantaged neighborhoods, less is known about how SES and other sociodemographic factors influence the timing of SCM initiation. This study investigated how neighborhood-level SES and patient characteristics shape the time to first SCM use among older adults with PC, both overall and by SCM subtype. Methods: We used SEER-Medicare data (2005–2020) to identify adults aged 65 and older diagnosed with PC who had continuous Medicare Parts A and B coverage for at least 90 days before diagnosis and Part D coverage for at least 30 days. SCM use was defined as at least one prescription claim post-diagnosis in one of five categories: analgesics, psychotropics, anti-nausea agents, appetite stimulants, or sleep aids. Neighborhood SES was assessed using the Yost Index and grouped into quintiles. Time to SCM initiation was assessed using multivariable Cox proportional hazards models. Hazard ratios (HRs) greater than 1 indicated earlier initiation; HRs less than 1 indicated delayed initiation. A two-sided p-value 0.05 was considered statistically significant. Results: Among 83,987 patients, lower SES was associated with delayed SCM initiation in a stepwise gradient, with the greatest delay observed in the lowest SES quintile (Q1 vs. Q5: HR 0.93, 95% CI: 0.89- 0.97). This gradient was consistent across SCM subtypes and most pronounced for psychotropics (HR 0.90, 0.84-0.95), sleep aids (HR 0.73, 0.65-0.80), and appetite stimulants (HR 0.88 0.83-0.94). Earlier SCM initiation was associated with advanced cancer stage, hospice enrollment, and prior SCM use. Regional and rural-urban differences also emerged, indicating geographic variation in care delivery. While race was not associated with overall SCM timing (e.g., Non-Hispanic Black vs. White: HR 0.998, 0.97-1.03), significant racial disparities emerged when stratified by SCM subtype. Non-Hispanic Black patients had earlier initiation of pain medications (HR 1.08 1.04-1.11) and appetite stimulants (HR 1.18 1.13-1.23), but delayed use of psychotropics (HR 0.69 0.66-0.72) and sleep aids (HR 0.62 0.57-0.68). Conclusion: Timing of SCM use among patients with PC is shaped by socioeconomic, geographic, and clinical factors. These findings highlight a socioeconomic gradient in symptom management, suggesting systematic delays in symptom management for socioeconomically disadvantaged patients. Additionally, while overall differences by race were not observed, disaggregated analyses by SCM subtype revealed important racial disparities that are obscured when SCMs are analyzed in aggregate. These findings highlight the need for disaggregated, equity-focused approaches to inform the development of targeted interventions that promote timely and equitable supportive care. Citation Format: John M. Allen, Kourtney A. Byrd, Olga M. Trejos Kweyete, Yi Guo, Shuang Yang, Xiwei Lou, Sherise C. Rogers, Lisa Scarton, Diana J. Wilkie. Socioeconomic and clinical determinants of timely supportive care medication use in pancreatic cancer: A national cohort study abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C048.