Disparity of Colon Cancer Outcomes in Rural America: Making the Case to Travel the Extra Mile.
OBJECTIVES: Rural patients experience disparities in cancer care compared to urban patients. We hypothesized that rural patients with colon cancer who traveled to high-volume centers for treatment have similar survival compared to urban patients who also traveled to high-volume centers to seek treatment for colon cancer. METHODS: The National Cancer Database was interrogated for patients treated for stage I-III colon cancer (2004-2015). Travel distance to treatment centers and annual hospital volume were divided into quartiles. Two groups of patients were identified and compared: (1) rural patients who traveled to high-volume hospitals and (2) urban patients who also traveled to high-volume centers. The primary outcome was overall survival (OS). RESULTS: Of 647,949 patients, 634, 447 were urban and 13,502 were rural. Rural patients were more likely to be Caucasian, with lower income, more comorbidities, and be treated at non-academic centers. In multivariable analysis, rural patients had worse OS compared to urban patients (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.04-1.12; p = < 0.001). There were 46,781 (7%) urban patients and 1276 (9%) rural patients who traveled a long distance (median 40 and 108 miles, respectively) to high-volume centers. There was no difference in adjusted OS between urban and rural patients who traveled to high-volume centers for treatment (HR 1.06; 95%CI 0.94-1.20; p = 0.36). CONCLUSIONS: This nationwide analysis suggests that rural patients with colon cancer experience worse survival than urban patients, but that this disparity might be mitigated by rural patients traveling to high-volume centers for treatment.
Raman, Vignesh, Mohamed A. Adam, Megan C. Turner, Harvey G. Moore, Christopher R. Mantyh, and John Migaly. “Disparity of Colon Cancer Outcomes in Rural America: Making the Case to Travel the Extra Mile.” J Gastrointest Surg 23, no. 11 (November 2019): 2285–93. https://doi.org/10.1007/s11605-019-04270-5.