Time Kills: Impact of Socioeconomic Deprivation on Timely Access to Guideline-Concordant Treatment in Foregut Cancer.

BACKGROUND: Receipt of guideline-concordant treatment (GCT) is associated with improved prognosis in foregut cancers. Studies show that patients living in areas of high neighborhood deprivation have worse healthcare outcomes, however its effect on GCT in foregut cancers has not been evaluated. We studied the impact of the Area Deprivation Index (ADI) as a barrier to GCT.

STUDY DESIGN: A single-institution retrospective review of 498 foregut cancer patients (gastric, pancreatic, and hepatobiliary adenocarcinoma) from 2018-2022 was performed. GCT was defined based on National Comprehensive Cancer Network guidelines. ADI, a validated measure of neighborhood disadvantage was divided into terciles (low, medium, and high) with high ADI indicating the most disadvantage.

RESULTS: 328/498 patients (66%) received GCT: 66%, 72% and 59% in pancreatic, gastric and hepatobiliary cancers, respectively. Median (IQR) time from symptoms to work-up was 6 weeks (3-13), from diagnosis to oncology appointment was 4 weeks (1-10) weeks, and from oncology appointment to treatment was 4 weeks (2-10). 46% were diagnosed in the Emergency Department (ED). On multivariable analyses, age ≥75 years [OR 0.39 (95% CI 0.18-0.87)], Black race [OR 0.52 (95% CI 0.31-0.86)], high ADI [0.25(0.14-0.48)], ≥6 weeks from symptoms to work-up [0.44(0.27-0.73)], ≥4 weeks from diagnosis to oncology appointment [0.76 (0.46-0.93)] and ≥4 weeks from oncology appointment to treatment [0.63 (0.36-0.98)] were independently associated with non-receipt of GCT.

CONCLUSIONS: Residence in an area of high deprivation predicts non-receipt of GCT. This is due to multiple individual and system level barriers. Identifying these barriers and developing effective interventions, including community outreach and collaboration, leveraging telehealth, and increasing oncologic expertise in under-served areas may improve access to GCT.