Spatial Analysis of Rural Disparities in Staging and Oncologic Outcomes for Esophageal and Pancreas Cancer

Background: Esophagectomy and pancreatectomy are complex surgical procedures that have demonstrated strong inverse relationships between hospital and surgeon volume and operative mortality, which has led to the implementation of national quality-improvement and process measures. Centralization of surgical management for esophageal and pancreas cancer has thus been endorsed to promote optimal oncologic care. Despite an impetus towards regionalization, rural access to specialty providers and facilities and disparities in staging and outcomes have yet to be investigated for these two particularly hard-to-treat cancers.

Project Lead: Sabha Ganai, MD, PhD

OPSP Team Members: Whitney Zahnd, MS

Collaborator: Min Lian, MD, PhD at Washington University School of Medicine in St. Louis, MO

Goals: Our goal is to examine population-level disparities in esophageal and pancreas cancer staging and outcomes that may be influenced by rurality, socioeconomic deprivation, and distance from providers such as endoscopic ultrasound (EUS)-trained gastroenterologists, specialty surgeons, and high-volume comprehensive cancer centers. This will be accomplished using spatial analysis to explore the influence of provider density and distance on oncologic outcomes.

Findings: To date, we have found a statistically significant inverse relationship between accessibility to EUS providers and county-level likelihood of having an unstaged pancreas cancer, indicating people who live further from specialty care may not receive the care necessary to improve prognosis of an already deadly disease. Further, we have been able to develop census-tract level spatial accessibility maps to visualize access to specialty care while accounting for access disparities and socioeconomic factors.

Citations:

Abstracts

1. Sturm EC, Zahnd W, Mellinger JD, Ganai S. Rural-Urban and Regional Differences in Receipt of Esophagectomy for Early-Stage Esophagus Cancer. Society for Surgery of the Alimentary Tract, 58th Annual Meeting, 2017 Digestive Disease Week, Chicago, Illinois, May 6-9, 2017.

2. MacKinney E, Zahnd W, Khan AA, Sturm E, Mellinger JD, Ganai S. An Exploration of Regional and Rural-Urban Differences in Pancreas Cancer Surgery. Society for Surgery of the Alimentary Tract, 58th Annual Meeting, 2017 Digestive Disease Week, Chicago, Illinois, May 6-9, 2017.

3. Khan AA, MacKinney E, Buckley EJ, Sturm E, Rejowski B, Mellinger JD, Ganai S. Adjacency of Rural County of Residence to an Urban County May Determine Survival for Stage I Pancreatic Cancer. Society for Surgery of the Alimentary Tract, 58th Annual Meeting, 2017 Digestive Disease Week, Chicago, Illinois, May 6-9, 2017.

4. Lanzotti NJ, Zahnd WE, Tseng JF, Mellinger JD, Ganai S. Impact of Travel Distance on Survival from Early-Stage Breast and Pancreas Cancer. Academic Surgical Congress 2017, Las Vegas, Nevada, February 2-5, 2017.

5. Regan J, Zahnd W, Kistner B, Ali A, Mellinger JD, Ganai S. Rural Disparities in Esophageal Cancer Outcomes based on Distance from Endoscopic Ultrasound (EUS)-Trained Gastroenterologists. Illinois Chapter of the American College of Surgeons, 65th Annual Scientific Meeting, Peoria, Illinois, June 18-20, 2015.