{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T09:00:37Z","timestamp":1791968437837,"version":"4.3.4"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical care for pancreatic ductal adenocarcinoma (PDAC) is increasingly centralized to high-volume hospitals (HVHs), prompting many patients to travel farther for resection. While surgery is centralized, adjuvant chemotherapy is often delivered locally, resulting in care fragmentation. The implications of this separation on chemotherapy receipt and survival are unclear. This study evaluated associations between travel distance, care fragmentation, and receipt of adjuvant chemotherapy in patients undergoing upfront PDAC resection at HVHs and assessed how these factors influenced overall survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with non-metastatic PDAC who underwent upfront resection at HVHs (\u226520 pancreatectomies\/year) were identified from the National Cancer Database (2007\u20132021). The cohort was stratified by adjuvant chemotherapy receipt, travel distance (deciles D1\u2013D10), and care fragmentation. Multivariable logistic regression assessed factors associated with chemotherapy receipt; Cox proportional hazards models evaluated survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 17,807 patients treated at 97 HVHs, 10,200 (57%) received adjuvant chemotherapy. Patients traveling \u226514 miles (\u2265D4) were less likely to receive adjuvant chemotherapy (D4 odds ratio [OR] 0.85; 95%\u00a0confidence interval [CI] 0.73\u20130.99;\n                      <jats:italic>P<\/jats:italic>\n                      =0.04). Patients experiencing care fragmentation were more likely to receive adjuvant therapy (64.3% vs. 54.4%, OR 1.51; 95% CI 1.35\u20131.69;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Travel \u226520 miles (\u2265D5) was associated with higher mortality (hazards ratio [HR] 1.12; 95% CI 1.02\u20131.23;\n                      <jats:italic>P<\/jats:italic>\n                      =0.01). Conversely, receipt of adjuvant chemotherapy (HR 0.77; 95% CI 0.73\u20130.81;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) and fragmented care (HR 0.89; 95% CI 0.84\u20130.93;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) were associated with improved survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Longer travel distance was associated with lower chemotherapy receipt and worse survival. Care fragmentation was linked to improved treatment access and survival, underscoring the need for coordinated cross-institutional care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-025-18539-4","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T14:11:04Z","timestamp":1760623864000},"page":"1576-1585","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association Between Fragmentation of Care and Delivery of Adjuvant Chemotherapy in Patients Traveling to High-Volume Hospitals for Pancreatic Adenocarcinoma"],"prefix":"10.1245","volume":"33","author":[{"given":"Alexa J.","family":"Hughes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen N.","family":"Kaiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Holler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Ruedinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita A.","family":"Turk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary Jo R.","family":"Schlick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"House","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Y. Bilimoria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"issue":"1","key":"18539_CR1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21551","volume":"69","author":"RL Siegel","year":"2019","unstructured":"Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7\u201334. https:\/\/doi.org\/10.3322\/caac.21551.","journal-title":"CA Cancer J Clin."},{"issue":"1","key":"18539_CR2","doi-asserted-by":"publisher","first-page":"16425","DOI":"10.1038\/s41598-020-73525-y","volume":"10","author":"A Bengtsson","year":"2020","unstructured":"Bengtsson A, Andersson R, Ansari D. The actual 5-year survivors of pancreatic ductal adenocarcinoma based on real-world data. Sci Rep. 2020;10(1):16425. https:\/\/doi.org\/10.1038\/s41598-020-73525-y.","journal-title":"Sci Rep."},{"issue":"12","key":"18539_CR3","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1056\/NEJMoa032295","volume":"350","author":"JP Neoptolemos","year":"2004","unstructured":"Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. New England Journal of Medicine. 2004;350(12):1200\u201310.","journal-title":"New England Journal of Medicine."},{"issue":"6","key":"18539_CR4","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1002\/cncr.22916","volume":"110","author":"KY Bilimoria","year":"2007","unstructured":"Bilimoria KY, Bentrem DJ, Ko CY, et al. Multimodality therapy for pancreatic cancer in the US: utilization, outcomes, and the effect of hospital volume. Cancer. 2007;110(6):1227\u201334. https:\/\/doi.org\/10.1002\/cncr.22916.","journal-title":"Cancer."},{"issue":"7","key":"18539_CR5","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.hpb.2017.03.002","volume":"19","author":"KT Ostapoff","year":"2017","unstructured":"Ostapoff KT, Gabriel E, Attwood K, Kuvshinoff BW, Nurkin SJ, Hochwald SN. Does adjuvant therapy improve overall survival for stage IA\/B pancreatic adenocarcinoma? HPB (Oxford). 2017;19(7):587\u201394. https:\/\/doi.org\/10.1016\/j.hpb.2017.03.002.","journal-title":"HPB (Oxford)."},{"issue":"12","key":"18539_CR6","doi-asserted-by":"publisher","first-page":"4108","DOI":"10.1245\/s10434-019-07602-6","volume":"26","author":"AM Altman","year":"2019","unstructured":"Altman AM, Wirth K, Marmor S, et al. Completion of Adjuvant Chemotherapy After Upfront Surgical Resection for Pancreatic Cancer Is Uncommon Yet Associated With Improved Survival. Annals of Surgical Oncology. 2019;26(12):4108\u201316. https:\/\/doi.org\/10.1245\/s10434-019-07602-6.","journal-title":"Annals of Surgical Oncology."},{"issue":"8","key":"18539_CR7","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1111\/j.1477-2574.2012.00496.x","volume":"14","author":"BC Visser","year":"2012","unstructured":"Visser BC, Ma Y, Zak Y, Poultsides GA, Norton JA, Rhoads KF. Failure to comply with NCCN guidelines for the management of pancreatic cancer compromises outcomes. Hpb. 2012;14(8):539\u201347.","journal-title":"Hpb."},{"issue":"2","key":"18539_CR8","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1097\/sla.0000000000000378","volume":"260","author":"RP Merkow","year":"2014","unstructured":"Merkow RP, Bilimoria KY, Tomlinson JS, et al. Postoperative Complications Reduce Adjuvant Chemotherapy Use in Resectable Pancreatic Cancer. Annals of Surgery. 2014;260(2):372\u20137. https:\/\/doi.org\/10.1097\/sla.0000000000000378.","journal-title":"Annals of Surgery."},{"key":"18539_CR9","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.amsu.2018.06.004","volume":"32","author":"M Weinrich","year":"2018","unstructured":"Weinrich M, Bochow J, Kutsch A-L, et al. High compliance with guideline recommendations but low completion rates of adjuvant chemotherapy in resected pancreatic cancer: a cohort study. Annals of Medicine and Surgery. 2018;32:32\u20137.","journal-title":"Annals of Medicine and Surgery."},{"issue":"3","key":"18539_CR10","doi-asserted-by":"publisher","first-page":"265","DOI":"10.3109\/0284186X.2015.1068445","volume":"55","author":"KJ Labori","year":"2016","unstructured":"Labori KJ, Katz MH, Tzeng CW, et al. Impact of early disease progression and surgical complications on adjuvant chemotherapy completion rates and survival in patients undergoing the surgery first approach for resectable pancreatic ductal adenocarcinoma \u2013 A population-based cohort study. Acta Oncologica. 2016;55(3):265\u201377. https:\/\/doi.org\/10.3109\/0284186X.2015.1068445.","journal-title":"Acta Oncologica."},{"issue":"25","key":"18539_CR11","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.1056\/NEJMoa1809775","volume":"379","author":"T Conroy","year":"2018","unstructured":"Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer. N Engl J Med. 2018;379(25):2395\u2013406. https:\/\/doi.org\/10.1056\/NEJMoa1809775.","journal-title":"N Engl J Med."},{"issue":"6","key":"18539_CR12","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1097\/ppo.0000000000000291","volume":"23","author":"RR White","year":"2017","unstructured":"White RR, Lowy AM. Clinical Management: Resectable Disease. Cancer J. 2017;23(6):343\u20139. https:\/\/doi.org\/10.1097\/ppo.0000000000000291.","journal-title":"Cancer J."},{"key":"18539_CR13","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.xjon.2022.11.017","volume":"13","author":"CD Logan","year":"2023","unstructured":"Logan CD, Ellis RJ, Feinglass J, et al. Association of travel distance, surgical volume, and receipt of adjuvant chemotherapy with survival among patients with resectable lung cancer. JTCVS Open. 2023;13:357\u201378. https:\/\/doi.org\/10.1016\/j.xjon.2022.11.017.","journal-title":"JTCVS Open."},{"issue":"11","key":"18539_CR14","doi-asserted-by":"publisher","first-page":"2824","DOI":"10.1245\/s10434-010-1159-0","volume":"17","author":"KB Stitzenberg","year":"2010","unstructured":"Stitzenberg KB, Meropol NJ. Trends in Centralization of Cancer Surgery. Annals of Surgical Oncology. 2010;17(11):2824\u201331. https:\/\/doi.org\/10.1245\/s10434-010-1159-0.","journal-title":"Annals of Surgical Oncology."},{"issue":"28","key":"18539_CR15","doi-asserted-by":"publisher","first-page":"4671","DOI":"10.1200\/jco.2008.20.1715","volume":"27","author":"KB Stitzenberg","year":"2009","unstructured":"Stitzenberg KB, Sigurdson ER, Egleston BL, Starkey RB, Meropol NJ. Centralization of Cancer Surgery: Implications for Patient Access to Optimal Care. Journal of Clinical Oncology. 2009;27(28):4671\u20138. https:\/\/doi.org\/10.1200\/jco.2008.20.1715.","journal-title":"Journal of Clinical Oncology."},{"issue":"3","key":"18539_CR16","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1245\/s10434-022-12908-z","volume":"30","author":"PM Kemp Bohan","year":"2023","unstructured":"Kemp Bohan PM, Chang SC, Grunkemeier GL, et al. Impact of Mediating and Confounding Variables on the Volume-Outcome Association in the Treatment of Pancreatic Cancer. Ann Surg Oncol. 2023;30(3):1436\u201348. https:\/\/doi.org\/10.1245\/s10434-022-12908-z.","journal-title":"Ann Surg Oncol."},{"issue":"2","key":"18539_CR17","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/sla.0000000000001924","volume":"266","author":"ME Lidsky","year":"2017","unstructured":"Lidsky ME, Sun Z, Nussbaum DP, Adam MA, Speicher PJ, Blazer DG 3rd. Going the Extra Mile: Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers. Ann Surg. 2017;266(2):333\u20138. https:\/\/doi.org\/10.1097\/sla.0000000000001924.","journal-title":"Ann Surg."},{"issue":"6","key":"18539_CR18","doi-asserted-by":"publisher","first-page":"e1250","DOI":"10.1097\/sla.0000000000005979","volume":"278","author":"MM Munir","year":"2023","unstructured":"Munir MM, Endo Y, Alaimo L, et al. Impact of Community Privilege on Access to Care Among Patients Following Complex Cancer Surgery. Ann Surg. 2023;278(6):e1250\u20138. https:\/\/doi.org\/10.1097\/sla.0000000000005979.","journal-title":"Ann Surg."},{"issue":"1","key":"18539_CR19","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1002\/jso.25374","volume":"120","author":"R Lentz","year":"2019","unstructured":"Lentz R, Benson AB 3rd, Kircher S. Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies. J Surg Oncol. 2019;120(1):85\u201392. https:\/\/doi.org\/10.1002\/jso.25374.","journal-title":"J Surg Oncol."},{"issue":"2","key":"18539_CR20","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1002\/jso.26706","volume":"125","author":"ZJ Brown","year":"2022","unstructured":"Brown ZJ, Labiner HE, Shen C, Ejaz A, Pawlik TM, Cloyd JM. Impact of care fragmentation on the outcomes of patients receiving neoadjuvant and adjuvant therapy for pancreatic adenocarcinoma. J Surg Oncol. 2022;125(2):185\u201393. https:\/\/doi.org\/10.1002\/jso.26706.","journal-title":"J Surg Oncol."},{"issue":"9","key":"18539_CR21","doi-asserted-by":"publisher","first-page":"5422","DOI":"10.1245\/s10434-022-12031-z","volume":"29","author":"KE Rhodin","year":"2022","unstructured":"Rhodin KE, Raman V, Eckhoff A, et al. Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer. Annals of Surgical Oncology. 2022;29(9):5422\u201331. https:\/\/doi.org\/10.1245\/s10434-022-12031-z.","journal-title":"Annals of Surgical Oncology."},{"issue":"5","key":"18539_CR22","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1007\/s11605-020-04760-x","volume":"25","author":"K Freischlag","year":"2021","unstructured":"Freischlag K, Olivere L, Turner M, Adam M, Mantyh C, Migaly J. Does Fragmentation of Care in Locally Advanced Rectal Cancer Increase Patient Mortality? J Gastrointest Surg. 2021;25(5):1287\u201396. https:\/\/doi.org\/10.1007\/s11605-020-04760-x.","journal-title":"J Gastrointest Surg."},{"issue":"19","key":"18539_CR23","doi-asserted-by":"publisher","first-page":"3428","DOI":"10.1002\/cncr.32336","volume":"125","author":"CA Hester","year":"2019","unstructured":"Hester CA, Karbhari N, Rich NE, et al. Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma. Cancer. 2019;125(19):3428\u201336. https:\/\/doi.org\/10.1002\/cncr.32336.","journal-title":"Cancer."},{"issue":"28","key":"18539_CR24","doi-asserted-by":"publisher","first-page":"4671","DOI":"10.1200\/jco.2008.20.1715","volume":"27","author":"KB Stitzenberg","year":"2009","unstructured":"Stitzenberg KB, Sigurdson ER, Egleston BL, Starkey RB, Meropol NJ. Centralization of cancer surgery: implications for patient access to optimal care. J Clin Oncol. 2009;27(28):4671\u20138. https:\/\/doi.org\/10.1200\/jco.2008.20.1715.","journal-title":"J Clin Oncol."},{"issue":"3","key":"18539_CR25","doi-asserted-by":"publisher","first-page":"202","DOI":"10.6004\/jnccn.2019.0014","volume":"17","author":"MA Tempero","year":"2019","unstructured":"Tempero MA, Malafa MP, Chiorean EG, et al. Pancreatic Adenocarcinoma. J Natl Compr Canc Netw. 2019;17(3):202\u201310. https:\/\/doi.org\/10.6004\/jnccn.2019.0014.","journal-title":"J Natl Compr Canc Netw."},{"issue":"3","key":"18539_CR26","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.surg.2018.01.006","volume":"165","author":"QL Hu","year":"2019","unstructured":"Hu QL, Ellis RJ, Ko CY. Databases for surgical health services research: National cancer database. Surgery. 2019;165(3):499\u2013500. https:\/\/doi.org\/10.1016\/j.surg.2018.01.006.","journal-title":"Surgery."},{"issue":"8","key":"18539_CR27","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1002\/jso.21173","volume":"99","author":"MV Raval","year":"2009","unstructured":"Raval MV, Bilimoria KY, Stewart AK, Bentrem DJ, Ko CY. Using the NCDB for cancer care improvement: An introduction to available quality assessment tools. Journal of Surgical Oncology. 2009;99(8):488\u201390. https:\/\/doi.org\/10.1002\/jso.21173.","journal-title":"Journal of Surgical Oncology."},{"issue":"4","key":"18539_CR28","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344\u20139. https:\/\/doi.org\/10.1016\/j.jclinepi.2007.11.008.","journal-title":"J Clin Epidemiol."},{"key":"18539_CR29","unstructured":"Group TL. Surgical Volume Standard. https:\/\/www.leapfroggroup.org\/"},{"issue":"10","key":"18539_CR30","first-page":"825","volume":"19","author":"JD Langley","year":"2013","unstructured":"Langley JD, Johnson TJ, Hohmann SF, Meurer SJ, Garman AN. Empirical analysis of domestic medical travel for elective cardiovascular procedures. Am J Manag Care. 2013;19(10):825\u201332.","journal-title":"Am J Manag Care."},{"issue":"3","key":"18539_CR31","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s10549-024-07442-3","volume":"208","author":"HD Freeman","year":"2024","unstructured":"Freeman HD, Burke LC, Humphrey JG, et al. Fragmentation of care in breast cancer: greater than the sum of its parts. Breast Cancer Res Treat. 2024;208(3):511\u201321. https:\/\/doi.org\/10.1007\/s10549-024-07442-3.","journal-title":"Breast Cancer Res Treat."},{"issue":"2","key":"18539_CR32","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/j.athoracsur.2022.06.049","volume":"115","author":"KE Rhodin","year":"2023","unstructured":"Rhodin KE, Raman V, Jensen CW, et al. Multi-institutional Care in Clinical Stage II and III Esophageal Cancer. The Annals of Thoracic Surgery. 2023;115(2):370\u20137. https:\/\/doi.org\/10.1016\/j.athoracsur.2022.06.049.","journal-title":"The Annals of Thoracic Surgery."},{"issue":"8","key":"18539_CR33","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1002\/jso.25750","volume":"120","author":"A Diaz","year":"2019","unstructured":"Diaz A, Burns S, Paredes AZ, Pawlik TM. Accessing surgical care for pancreaticoduodenectomy: Patient variation in travel distance and choice to bypass hospitals to reach higher volume centers. J Surg Oncol. 2019;120(8):1318\u201326. https:\/\/doi.org\/10.1002\/jso.25750.","journal-title":"J Surg Oncol."},{"issue":"12","key":"18539_CR34","doi-asserted-by":"publisher","first-page":"834.e9","DOI":"10.1016\/j.urolonc.2021.04.030","volume":"39","author":"KR Pekala","year":"2021","unstructured":"Pekala KR, Yabes JG, Bandari J, et al. The centralization of bladder cancer care and its implications for patient travel distance. Urol Oncol. 2021;39(12):834.e9-834.e20. https:\/\/doi.org\/10.1016\/j.urolonc.2021.04.030.","journal-title":"Urol Oncol."},{"key":"18539_CR35","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2024.07.059","volume":"179","author":"JS Lim","year":"2025","unstructured":"Lim JS, Lozano V, Heard J, et al. Redefining at-risk patients undergoiong pancreaticoduodenectomy: Impact of socioeconomic factors including Area Deprivation Index and distance traveled. Surgery. 2025;179:108804. https:\/\/doi.org\/10.1016\/j.surg.2024.07.059.","journal-title":"Surgery."},{"issue":"1","key":"18539_CR36","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1002\/bjs5.50115","volume":"3","author":"N Latchana","year":"2019","unstructured":"Latchana N, Davis L, Coburn NG, et al. Population-based study of the impact of surgical and adjuvant therapy at the same or a different institution on survival of patients with pancreatic adenocarcinoma. BJS Open. 2019;3(1):85\u201394. https:\/\/doi.org\/10.1002\/bjs5.50115.","journal-title":"BJS Open."},{"issue":"3","key":"18539_CR37","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1016\/j.surg.2023.08.040","volume":"175","author":"SS Park","year":"2024","unstructured":"Park SS, Verm RA, Abdelsattar ZM, et al. Fragmented care in localized pancreatic cancer: Is commission on cancer accreditation associated with improved overall survival? Surgery. 2024;175(3):695\u2013703. https:\/\/doi.org\/10.1016\/j.surg.2023.08.040.","journal-title":"Surgery."},{"issue":"3","key":"18539_CR38","doi-asserted-by":"publisher","first-page":"255.e1","DOI":"10.1016\/j.ajog.2019.09.005","volume":"222","author":"S Cham","year":"2020","unstructured":"Cham S, Wen T, Friedman A, Wright JD. Fragmentation of postoperative care after surgical management of ovarian cancer at 30 days and 90 days. American Journal of Obstetrics and Gynecology. 2020;222(3):255.e1-255.e20. https:\/\/doi.org\/10.1016\/j.ajog.2019.09.005.","journal-title":"American Journal of Obstetrics and Gynecology"},{"issue":"11","key":"18539_CR39","doi-asserted-by":"publisher","first-page":"2837","DOI":"10.1002\/cncr.26601","volume":"118","author":"TA Skolarus","year":"2012","unstructured":"Skolarus TA, Zhang Y, Hollenbeck BK. Understanding fragmentation of prostate cancer survivorship care: implications for cost and quality. Cancer. 2012;118(11):2837\u201345. https:\/\/doi.org\/10.1002\/cncr.26601.","journal-title":"Cancer."},{"issue":"34","key":"18539_CR40","doi-asserted-by":"publisher","first-page":"3234","DOI":"10.1200\/jco.18.02035","volume":"37","author":"KH Sheetz","year":"2019","unstructured":"Sheetz KH, Dimick JB, Nathan H. Centralization of High-Risk Cancer Surgery Within Existing Hospital Systems. J Clin Oncol. 2019;37(34):3234\u201342. https:\/\/doi.org\/10.1200\/jco.18.02035.","journal-title":"J Clin Oncol."},{"issue":"1","key":"18539_CR41","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/sla.0000000000004451","volume":"273","author":"MR Poulson","year":"2021","unstructured":"Poulson MR, Beaulieu-Jones BR, Kenzik KM, et al. Residential Racial Segregation and Disparities in Breast Cancer Presentation, Treatment, and Survival. Ann Surg. 2021;273(1):3\u20139. https:\/\/doi.org\/10.1097\/sla.0000000000004451.","journal-title":"Ann Surg."},{"issue":"8","key":"18539_CR42","doi-asserted-by":"publisher","first-page":"4826","DOI":"10.1245\/s10434-023-13449-9","volume":"30","author":"MM Munir","year":"2023","unstructured":"Munir MM, Woldesenbet S, Endo Y, et al. Disparities in Socioeconomic Factors Mediate the Impact of Racial Segregation Among Patients With Hepatopancreaticobiliary Cancer. Ann Surg Oncol. 2023;30(8):4826\u201335. https:\/\/doi.org\/10.1245\/s10434-023-13449-9.","journal-title":"Ann Surg Oncol."},{"issue":"11","key":"18539_CR43","doi-asserted-by":"publisher","first-page":"6790","DOI":"10.1245\/s10434-021-09823-0","volume":"28","author":"SK Kamarajah","year":"2021","unstructured":"Kamarajah SK, White SA, Naffouje SA, Salti GI, Dahdaleh F. Adjuvant Chemotherapy Associated with Survival Benefit Following Neoadjuvant Chemotherapy and Pancreatectomy for Pancreatic Ductal Adenocarcinoma: A Population-Based Cohort Study. Ann Surg Oncol. 2021;28(11):6790\u2013802. https:\/\/doi.org\/10.1245\/s10434-021-09823-0.","journal-title":"Ann Surg Oncol."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-18539-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-025-18539-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-18539-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T13:06:10Z","timestamp":1767618370000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-025-18539-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":43,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["18539"],"URL":"https:\/\/doi.org\/10.1245\/s10434-025-18539-4","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]},"assertion":[{"value":"1 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"No other disclosures were reported.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}