Abstract B124: Food accessibility and its impact on clinical outcomes in patients undergoing surgery for pancreatic ductal adenocarcinoma
Authors: Liu Christopher M. , Freudenberger Devon C. , Rustom Salem , Vudatha Vignesh , Raman Shreya , Devarakonda Teja , Herremans Kelly M. , Riner Andrea N. , Wolfe Luke , Trevino Jose G. 
Published: January 2023

Abstract
Accessing healthy food is paramount to one’s nutritional status, a known factor in postoperative morbidity and long-term mortality. The relationship between a patient’s food accessibility and outcomes following surgical resection in pancreatic ductal adenocarcinoma (PDAC) is unknown. The objective of this study was to compare postoperative outcomes and long-term survival of PDAC patients residing in low and high food accessibility areas who underwent surgical resection. Adult PDAC patients undergoing surgical resection at a single tertiary academic center from 2011 to 2021 were identified retrospectively. Patient addresses were mapped onto the United States Department of Agriculture (USDA) Food Access Research Atlas to determine food accessibility status. Those with residence in areas designated by the USDA as having limited access to healthy food were classified as having “low food accessibility” (LFA). Those not classified as having LFA were labeled as having “high food accessibility” (HFA). Demographics, comorbidities, neoadjuvant treatment status, tumor characteristics, postoperative complications, hospital stay characteristics, overall survival, and recurrence rates were collected. Data were evaluated using descriptive statistics and Cox-Proportional Hazard models for survival. In total, 89 patients met inclusion criteria, of which 23 (25.8%) patients resided in areas of LFA. No significant differences existed in patient age, sex, or other sociodemographics. Patient BMI was higher for LFA patients than HFA patients (28.3 vs 24.6, p = 0.0070). Major comorbidities were comparable except for an increased rate of diabetes in LFA patients (56.5% vs 29.2%, p = 0.0194). Both groups underwent neoadjuvant treatment at similar rates. Tumor grade was significantly different for the groups with LFA patients having higher rates of poor differentiation compared to HFA patients (39.1% G3 vs 9.4% G3, p = 0.0015). Lymphovascular invasion, perineural invasion, and number of positive lymph nodes were similar. Minor complications, readmission, and recurrence did not demonstrate differences between groups but LFA patients suffered from higher rates of major complication (52.2% vs 27.3%, p = 0.0296). Total hospital length of stay and ICU length of stay were also similar. Overall survival was 12.1 months in LFA patients and 15.2 months in HFA patients but was not significantly different (p = 0.16). Low food accessibility is associated with greater rates of major complications in PDAC patients undergoing tumor resection yet does not significantly impact overall survival in this deadly disease. Awareness of patient food accessibility status may be beneficial in recognizing those who might benefit the most from nutritional prehabilitation and those less able to act on nutritional recommendations.
Citation Format: Christopher M. Liu, Devon C. Freudenberger, Salem Rustom, Vignesh Vudatha, Shreya Raman, Teja Devarakonda, Kelly M. Herremans, Andrea N. Riner, Luke Wolfe, Jose G. Trevino. Food accessibility and its impact on clinical outcomes in patients undergoing surgery for pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B124.