{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T17:58:29Z","timestamp":1790531909911,"version":"4.1.0"},"reference-count":53,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multimodal therapy (MMT) combining surgery and chemotherapy remains the optimal management strategy irrespective of sequence for resectable pancreatic ductal adenocarcinoma (PDAC). Determinants of MMT receipt and sequencing remain incompletely understood, particularly regarding neoadjuvant strategies. We aimed to identify modifiable characteristics contributing to differences in MMT receipt and sequencing in the surgical PDAC population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the 2023 National Cancer Database, we analyzed 11\u2009202 adults with non\u2010metastatic resectable PDAC (2010\u20132020). Patients were grouped into four treatment categories: surgery only, neoadjuvant chemotherapy plus surgery, adjuvant chemotherapy plus surgery, and combined neoadjuvant plus adjuvant chemotherapy with surgery. Outcomes included 5\u2010year overall survival and multivariable logistic regression for chemotherapy receipt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 11\u2009202 patients, 3605 (32.2%) underwent surgery alone, 6347 (56.7%) received adjuvant chemotherapy, 626 (5.6%) neoadjuvant chemotherapy, and 624 (5.6%) both. Surgery\u2010only patients were older, Medicare\u2010insured, and treated at community, low\u2010volume centers, while MMT patients were younger and privately insured (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Five\u2010year survival was highest with combined neoadjuvant and adjuvant therapy (31.9%). Older age, Medicaid insurance, community centers, low\/intermediate\u2010volume facilities, and higher comorbidity burden were associated with reduced odds of MMT receipt (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Disparities continue to exist for MMT in the PDAC surgical population, highlighting opportunities for improved patient education and enhanced multidisciplinary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70408","type":"journal-article","created":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T17:55:30Z","timestamp":1790531730000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Missed Opportunities for Multimodality Therapy in Resectable Pancreatic Cancer: National Disparities and Consequences for Survival"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4044-1647","authenticated-orcid":false,"given":"John","family":"Johnson","sequence":"first","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Erstad","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"},{"name":"Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Euberto Mendez","family":"Reyes","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Silberfein","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"},{"name":"Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7637-3717","authenticated-orcid":false,"given":"George Van","family":"Buren","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"},{"name":"Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Fisher","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"},{"name":"Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0005-7536","authenticated-orcid":false,"given":"E Ramsay","family":"Camp","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"},{"name":"Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"issue":"1","key":"e_1_2_11_2_1","first-page":"7","article-title":"Cancer Statistics, 2020","volume":"70","author":"Siegel R. 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