Combined Association of Time to Treatment, Guideline Concordance, and Neighborhood Vulnerability with Localized Colon Cancer, Non-small-cell Lung Cancer, and Pancreatic Cancer Survival

BACKGROUND: Patients with social barriers have poor cancer outcomes. The combined relationship of cancer survival with guideline concordance, time to treatment, and social vulnerability has not been studied. Our objective was to determine whether optimal care is associated with survival and whether this relationship differs with social vulnerability. METHODS: Adult patients diagnosed with localized colon cancer, non-small-cell lung cancer (NSCLC), or pancreatic cancer from 2006 to 2016 and followed until 2021 were identified from California and Texas Cancer Registries and analyzed with the census-tract level Social Vulnerability Index. Optimal care (guideline-concordant treatment initiated within 60 days of diagnosis) was used to create an interaction variable by combining it with the Social Vulnerability Index. A multivariable Cox proportional hazards model was used for survival analysis. RESULTS: Of the 100,294 patients, 68.7% of those with colon cancer, 22.6% of those with pancreatic cancer, and 70.6% of those with NSCLC received optimal care. Cox models showed that patients who received optimal care had the lowest hazard ratios (HRs) for death compared with those who received least optimal care: colon cancer, HR 0.45 (95% confidence interval [CI] 0.36-0.57), NSCLC, HR 0.35 (95% CI 0.32-0.38), pancreatic cancer, HR 0.46 (95% CI 0.39-0.54). On interaction analysis, for patients with colon cancer or NSCLC who received optimal care, the risk of death was higher for patients who lived in the most vulnerable neighborhoods than for those who did not. CONCLUSION: Care that is both guideline concordant and timely is associated with the highest overall survival for localized cancer. However, this association is reduced for patients with colon cancer or NSCLC residing in the most vulnerable neighborhoods.