# The Impact of Social Determinants of Health on Supportive and Palliative Care in Pancreatic Cancer Management: A Narrative Review

## TL;DR

This paper reviews how social factors like income and race affect access to supportive care for pancreatic cancer patients, highlighting disparities in pain management, nutrition, and end-of-life planning.

## Contribution

The paper provides a comprehensive narrative review linking social determinants of health to disparities in supportive and palliative care for pancreatic cancer patients.

## Key findings

- Racial disparities exist in pain medication and nutritional care for pancreatic cancer patients.
- Non-White and less-educated patients are less likely to engage in end-of-life planning.
- Low-income and minority patients are less likely to receive care at high-volume treatment centers.

## Abstract

Pancreatic cancer is one of the deadliest solid organ malignancies, with a 5-year survival rate of 13% across all stages of disease. Supportive and palliative care are critical aspects of patient management and can be impacted by social determinants of health (SDOH), such as income, education, and access to healthcare. This review demonstrates that racial disparities exist in receipt of pain medication and nutritional care, educational disparities in terms of accessing psychological support, and that end-of-life planning is less common among non-White and less-educated patients. These gaps also extend to rehabilitation services and telehealth. High-volume treatment centers show better outcomes for all patients, but minorities and low-income patients are less likely to receive care there. Addressing these disparities requires coordinated efforts at clinical, organizational, and policy levels to ensure equitable access to care for all pancreatic cancer patients.

Background: Pancreatic cancer is a challenging malignancy with an aggressive biology and limited treatment options, contributing to low survival rates. Supportive and palliative care play a key role in improving the quality of life and psychological distress for patients and their families. However, appropriate delivery and effectiveness of these interventions may be influenced by social determinants of health (SDOH). These factors create significant barriers for patients, influencing their access to care and ability to make informed decisions. This review explores the role of SDOH in supportive and palliative care of pancreatic cancer patients and identifies areas for improvement to enhance this type of care for vulnerable populations. Methods: A thorough narrative review was carried out to evaluate the influence of social determinants of health on supportive and palliative care in the management of pancreatic cancer, focusing on symptom management, psychosocial support, nutritional support, advance care planning, rehabilitation, functional support, and care coordination. Results: This review demonstrates that disparities exist. Black and Asian patients receive less pain medications; those with lower level of education struggle to access psychological support; Hispanic and Black patients often do not receive needed nutritional care; and end-of-life planning is less common among non-White and less-educated patients. Conclusions: SDOH significantly affects the experience and delivery of supportive and palliative care in pancreatic cancer patients, exacerbating inequities across multiple domains of care. Addressing these disparities requires coordinated efforts at clinical, organizational, and policy levels to ensure equitable access to care for all patients in their final phase of life. Integrating attention to SODH into care delivery models can improve outcomes and enhance quality of life for these patients.