V. Raman1, M. A. Adam1, M. Turner1, H. Moore1, C. Mantyh1, J. Migaly1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction:
Rural disparity in colon cancer care may exist, with potential compromised outcomes for rural dwellers. However, it is unclear if this disparity could be mitigated by traveling to high-volume centers, given concerns for travel burden and wait times. The objectives of this study were to characterize outcomes from colon cancer patients based on rurality and compare the outcomes of rural patients who traveled to high-volume centers to urban patients who traveled to high-volume centers.
Methods:
Patients treated for colon cancer were identified from the National Cancer Database (2004-2014). Travel distance to treatment centers and annual hospital volume were divided into quartiles. Overlaying rural status with the upper quartiles of travel distance with hospital volume status was employed to identify 2 groups: (1) rural patients who traveled to high-volume hospitals, (2) urban patients who traveled to high-volume hospitals. Outcomes were compared after adjustment for clinicopathologic tumor characteristics, and surgical therapy.
Results:
A total of 503,438 patients were included; 492883 patients from urban areas and 10555 patients from rural areas. Rural vs urban patients more often were White, had lower income, more comorbid conditions, and received treatment at non-academic centers (all p<0.05). While extent of surgery was not different between groups, rural patients had higher 90-day mortality (7% vs 6%, p=0.002). Unadjusted 10-year overall survival was significantly shorter for the rural group (37% vs 39%, p<0.0001). After adjustment, survival remained significantly compromised among rural patients (HR 1.06, p=0.0003). There were 31499 urban patients who travel a long distance (mean 40 miles) to high-volume centers (mean137 cases/yr) and 701 rural patients who travel a long distance (mean 108 miles) to high-volume centers (139 cases/yr). Unadjusted 10-year survival was equivalent between rural vs urban patients who travelled to high-volume centers (42% vs 45%, p<0.39), even after adjustment for patient and tumor characteristics (HR 1.097, p=0.25).
Conclusion:
This national study suggests that rural disparity exists in colon cancer, with compromised outcomes for rural patients. Despite concerns for travel burden and the potential for longer wait times, rural patients who travel to high-volume centers appear to have similar survival to urban patients who travel to high-volume centers. This data may encourage rural providers, patients and policymakers to facilitate referral to high-volume centers for this disadvantaged population.