Pancreatic cancer outcomes among vulnerable demographics

Pancreatic cancer is the third deadliest cancer in the United States with a five-year survival rate of ten percent. While pancreatic cancer caught in its early stages has more positive treatment outcomes, demographics present disparate hurdles in access to care. Much research has shown disproportionate pancreatic cancer disparities between age, race and gender groups. However, there is little evidence on the relationship between delayed pancreatic cancer care and a patient’s geographic location.

Rosevine A. Azap, a rising third-year medical student at the Ohio State University College of Medicine, sought to fill in this gap by exploring the impact of unequal geographic barriers among pancreatic cancer patients. Her study reviewed the social determinants of health and their impact on patients receiving treatment for early-stage pancreatic adenocarcinoma cancer (PDAC). Rosevine Azap chose to study this avenue of pancreatic care with the understanding that the influence of factors outside of one’s physical health may potentially provide valuable information to improve patient outcomes.

The study reviewed data collected from 15,931 Medicare beneficiary patients and measured the scope of their social determinants through the Centers for Disease Control and Prevention’s (CDC) Social Vulnerability Index (SVI). This index compiles socioeconomic status, language barriers, housing structures, minority status, age and disability to evaluate the level of social vulnerability of various counties across the U.S. Rosevine Azap hypothesized that patients in counties with a high SVI score were less likely to receive surgical treatment for PDAC.

Rosevine conducted the study under the mentorship of Timothy Pawlik, MD, PhD, MPH, professor and chair of Surgery at the Ohio State University College of Medicine.

“Rosevine Azap should be congratulated on this important study, which demonstrated the impact of social vulnerability on cancer surgery outcomes. While many of us think that only clinical factors drive therapeutic decisions, in reality other factors such as social vulnerability and the circumstances of our ‘lived experience’ greatly impact the access to care and long-term oncologic outcomes,” says Dr. Pawlik.

Rosevine Azap found that vulnerable demographics were less likely to receive pancreatic resection. This observation lay parallel to minority trends, with minorities receiving less treatment than white patients. In addition, she found that patients in vulnerable counties were less likely to receive chemotherapy. Prognoses also varied across this index. Patients with high SVI scores presented higher 1, 3, and 5-year mortality rates. Patients from low SVI counties had a 57% mortality rate, whereas patients from high SVI counties showed a 63.4% 1-year mortality rate.

“Not only does this prove disparate pancreatic cancer outcomes among varying demographics, these data emphasize the importance of health care providers, including surgeons, screening for social determinants of health among patients with complex medical and surgical needs, especially cancer,” says Rosevine Azap.

Equipped with this data, Rosevine Azap infers that the obstacles to accessing optimal pancreatic cancer healthcare may be at the community level. She urges future research to investigate the underlying mechanisms of this phenomenon. Factors such as access to care, communal resources, and physician implicit bias may play a role in the outcomes observed in this particular study.

“This research helps set the foundation for health care providers and policymakers seeking to implement and leverage social services to improve health care access,” says Rosevine Azap.

In clarifying the contributors to this health dilemma, Rosevine Azap endows providers with a deep-er insight on resource allocation and services to patients in need, as well as understanding the importance of being proactive in overseeing transitions of care for vulnerable populations.

“Rosevine Azap is a wonderful student, an emerging academic star and someone who we hope will choose surgery as her career. In addition to this current paper, Rosevine has published several other important papers in various surgical journals,” says Dr. Pawlik.


Azap RA, Diaz A, Hyer JM, et al. Impact of Race/Ethnicity and County-Level Vulnerability on Receipt of Surgery Among Older Medicare Beneficiaries With the Diagnosis of Early Pancreatic Cancer [published online ahead of print, 2021 Apr 12]. Ann Surg Oncol. 2021;10.1245/s10434-021-09911-1. doi:10.1245/s10434-021-09911-1