Temple University Hospital and Fox Chase Researchers Investigate Relationship Between Fragmented Care and Social and Demographic Disparities

Dr. Taylor
Maryclare Taylor, MD, a general surgery resident at Temple University Hospital, presented a study at the 65th Annual Meeting of the Society for Surgery of the Alimentary Tract that found that pancreatic cancer patients who received single modality neoadjuvant therapy experienced fragmented care more often than patients who received total neoadjuvant therapy.

PHILADELPHIA (May 20, 2024) — Pancreatic cancer patients who received single modality neoadjuvant therapy experienced fragmented care, which is care at multiple centers, more often compared with those who received total neoadjuvant therapy, according to a study from researchers at Temple University Hospital and Fox Chase Cancer Center. The research was presented today at Digestive Disease Week (DDW). 

Neoadjuvant therapy refers to treatment a patient receives before surgery to improve the success of their main treatment. It can include chemotherapy or radiation therapy either alone or in combination. In single modality neoadjuvant therapy (SMNT), patients are treated with either chemotherapy or chemoradiation before surgery. In total neoadjuvant therapy (TNT), patients are treated with both chemotherapy and chemoradiation before surgery. 

“There are so many human factors at play from the point of diagnosis through treatment. A person with pancreatic cancer may be diagnosed at a different location than where they receive chemotherapy/radiation, and that may be a different location than where they undergo surgery,” said Maryclare Taylor, MD, first author on the study and a general surgery resident at Temple University Hospital. 

“We wanted to look into how this fragmentation of care affects patient outcomes and how sociodemographic factors come into play,” she said. 

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In the study, researchers examined a cohort of pancreatic cancer patients who received neoadjuvant therapy to evaluate if sociodemographic disparities can help predict which patients receive fragmented care. Predictors included age at diagnosis, race/ethnicity, and median household income. Researchers also used the social vulnerability index (SVI) score, a scale used by the Centers for Disease Control and Prevention to measure socioeconomic status, household characteristics, minority status, and housing/transportation. 

Out of 256 patients with pancreatic adenocarcinoma, 115 patients received neoadjuvant therapy. Twenty-nine of those patients were treated with SMNT and 86 were treated with TNT. 

When the SMNT and TNT groups were compared for differences in sociodemographic disparity predictors, no significant difference was found between the median age, race/ethnicity, median household income, or SVI score. 

However, the study showed that patients who received SMNT were more likely to experience fragmentation of care than those who received TNT, with 72% of the SMNT patients experiencing fragmented care as opposed to 48% of the TNT patients. 

“Among the SMNT cohort, SVI score was higher amongst patients who experienced fragmented care, indicating a higher level of vulnerability per county in the SMNT patients who received fragmented care,” Taylor said. 

“Recognizing how sociodemographic disparities impact fragmentation of care is pivotal in the understanding of how this newly emerging concept of fragmented care affects cancer patients.” 

Taylor presented findings from the study, “Understanding Fragmented Pancreatic Cancer Care in Patients Receiving Neoadjuvant Therapy: Are Sociodemographic Disparities Predictive of Patients Receiving Fragmented Care?,” in an oral session organized by the Society for Surgery of the Alimentary Tract, a co-sponsor of DDW, which is being held May 18-21 in Washington, D.C.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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