{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:03:28Z","timestamp":1781006608771,"version":"3.54.1"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: Health accessibility is a key determinant of equitable cancer care. In many countries, specialized oncology services are concentrated in urban and socioeconomically advantaged regions, forcing many patients to travel long distances for treatment. Consequently, geographic and social characteristics may be impactful in determining cancer healthcare outcomes. Objective: The aim of this study was to evaluate the association between the municipal-level Social Progress Index (SPI) and geographic travel burden, stage at diagnosis, treatment, and survival in patients with pancreatic cancer in S\u00e3o Paulo state, Brazil. Methods: We conducted a population-based study using data from \u201cFunda\u00e7\u00e3o Oncocentro\u201d on adults with pancreatic adenocarcinoma (2005\u20132025). The SPI (0\u2013100 scale), a composite measure of municipal social and environmental development, was the primary exposure. It is structured into 3 dimensions and 12 components: Basic Human Needs (nutrition, medical care, water and sanitation, housing, safety); Foundations of Well-being (education, information access, health, environmental quality); and Opportunity (rights, freedom of choice, social inclusion, higher education). Municipal residence and cancer center locations were geocoded, and travel distance (km) was estimated. Multivariable Cox, logistic, and linear regression models assessed associations between SPI and overall survival, stage IV at diagnosis, surgery, and travel distance. Results: A total of 13,478 patients were included (mean follow-up 15.1 \u00b1 27.2 months; mean age 62.3 years; 50.4% male). Stage IV disease was frequent (46.3%), and surgery was performed in 33% of cases. Over half of patients (53.2%) traveled more than 10 km for treatment. Increasing SPI was strongly associated with shorter travel distance (\u03b2 \u221262.6 km per SPI unit; p &lt; 0.001) and higher odds of surgery (OR 1.04; p &lt; 0.001) and remained independently associated with a higher likelihood of undergoing surgical treatment (adjusted OR 1.04; p &lt; 0.001). The proportion of stage IV disease did not decrease with increasing SPI and was slightly higher in the highest quartile (49.3%). In survival analysis, SPI demonstrated a protective effect in univariate modeling (HR 0.987; p &lt; 0.001), but lost significance in multivariable analysis (p = 0.125). Travel burden was not retained as an independent predictor of survival after adjustment. Conclusions: Municipal-level SPI was a strong determinant of healthcare access and the likelihood of receiving surgical treatment for pancreatic cancer. Social and geographic vulnerability directly influence care pathways, revealing structural inequities in access to treatment. SPI-based stratification may serve as a practical tool to identify priority regions for transport support and equitable allocation of oncology services.<\/jats:p>","DOI":"10.3390\/curroncol33060346","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:46:54Z","timestamp":1780998414000},"page":"346","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Social Progress Index as a Determinant of Healthcare Access and Treatment in Pancreatic Cancer"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6695-0496","authenticated-orcid":false,"given":"Francisco","family":"Tustumi","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe Antonio Boff","family":"Maegawa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0124-0076","authenticated-orcid":false,"given":"Vict\u00f3ria Bulc\u00e3o","family":"Caraciolo","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna Mennitti","family":"Shimoda","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella Paes Leme","family":"Rufino","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6845-1144","authenticated-orcid":false,"given":"Bianca Aguiar Giacometti","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8334-4846","authenticated-orcid":false,"given":"Lucas Cata Preta","family":"Stolzemburg","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9727-9241","authenticated-orcid":false,"given":"Daniel Jos\u00e9","family":"Szor","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Eduardo Alonso","family":"Araujo","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6122-1374","authenticated-orcid":false,"given":"Pedro Luiz Serrano","family":"Uson Junior","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Wolosker","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Einstein Hospital Israelita, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref_1","first-page":"105","article-title":"Enhancing Global Access to Cancer Medicines","volume":"70","author":"Cortes","year":"2020","journal-title":"CA Cancer J. 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