Rurality and Other Determinants of Early Colorectal Cancer Diagnosis in Nebraska: A 6‐Year Cancer Registry Study, 1998‐2003

Sankaranarayanan, Jayashri; Watanabe‐Galloway, Shinobu; Sun, Junfeng; Qiu, Fang; Boilesen, Eugene; Thorson, Alan G.

doi:10.1111/j.1748-0361.2009.00244.x

Cited by 22 publications

(21 citation statements)

References 24 publications

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“…7 Furthermore, colon cancer tends to be diagnosed at later stages in rural patients. 8–10 We have previously explored the impact of the location of treatment on outcomes, specifically demonstrating that treatment at a rural hospital did not confer worse surgical mortality except for in patients with complex cancers. 11 However, an effective appraisal of quality cancer care should more broadly consider the structures, processes and outcomes of cancer care.…”

Section: Introductionmentioning

confidence: 99%

Does Patient Rurality Predict Quality Colon Cancer Care?

Chow

Al‐Refaie

Abraham

et al. 2015

Diseases of the Colon &Amp; Rectum

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Background Over fifty million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized, despite its known impact on screening. Objective Our study sought to examine the impact of patient rurality on quality and comprehensive colon cancer care. Design Using the 1996–2008 California Cancer Registry, we constructed a retrospective cohort of 123,129 patients with stage 0–IV colon cancer. Rural residence was established based on the patient’s medical service study area designated by the registry. Patients All patients diagnosed between 1996–2008 with tumors located in the colon were eligible for inclusion in this study. Main Outcome Measures Baseline characteristics were compared by rurality status. Multivariate regression models then were used to examine the impact of rurality on stage in the entire cohort, adequate lymphadenectomy in stage I–III disease and receipt of chemotherapy for stage III disease. Proportional hazards regression was used to examine the impact of rurality on cancer specific survival. Results Of all patients diagnosed with colon cancer, 18,735 (15%) resided in rural areas. Our multivariate models demonstrate that rurality was associated with later stage of diagnosis, inadequate lymphadenectomy in stage I–III disease and lower likelihood of receiving chemotherapy for stage III disease. In addition, rurality was associated with worse cancer specific survival. Limitations We could not account for socioeconomic status directly, though we used insurance status as one surrogate. Furthermore, we did not have access to treatment location or distance traveled. We also could not account for provider or hospital case volume, patient comorbidities nor complications. Conclusions A significant portion of patients treated for colon cancer live in rural areas. Yet, rural residence is associated with modest differences in stage, adherence to quality measures and survival. Future endeavors should help improve care to this vulnerable population (see SDC1: video abstract).

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Section: Introductionmentioning

confidence: 99%

Does Patient Rurality Predict Quality Colon Cancer Care?

Chow

Al‐Refaie

Abraham

et al. 2015

Diseases of the Colon &Amp; Rectum

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“…With major medical centres being concentrated in densely populated urban centres, it has been suggested that rural and remote locations may be associated with poorer access to screening and specialised health care (Parikh-Patel et al , 2006; Heathcote and Armstrong, 2007). However ecological studies have presented a mixed picture in terms of SES (Parikh-Patel et al , 2006; Frederiksen et al , 2008; Henry et al , 2009; Booth et al , 2010) and geographic remoteness (Fazio et al , 2005; McLafferty and Wang, 2009; Sankaranarayanan et al , 2009) in stage at diagnosis.…”

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confidence: 99%

Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study

et al. 2011

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Background:We examine the relationships between geographic remoteness, area disadvantage and risk of advanced colorectal cancer.Methods:Multilevel models were used to assess the area- and individual-level contributions to the risk of advanced disease among people aged 20–79 years diagnosed with colorectal cancer in Queensland, Australia between 1997 and 2007 (n=18 561).Results:Multilevel analysis showed that colorectal cancer patients living in inner regional (OR=1.09, 1.01–1.19) and outer regional (OR=1.11, 1.01–1.22) areas were significantly more likely to be diagnosed with advanced cancer than those in major cities (P=0.045) after adjusting for individual-level variables. The best-fitting final model did not include area disadvantage. Stratified analysis suggested this remoteness effect was limited to people diagnosed with colon cancer (P=0.048) and not significant for rectal cancer patients (P=0.873).Conclusion:Given the relationship between stage and survival outcomes, it is imperative that the reasons for these rurality inequities in advanced disease be identified and addressed.

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“…Other studies imputed stage information [15,19], or analysed missing stage as a separate group [35]. Average stage at diagnosis varied by tumour site [38], histological type for ovarian cancer [20], and by subsite for colorectal cancer [33]. …”

Section: Resultsmentioning

confidence: 99%

“…Average stage at diagnosis varied by tumour site [38], histological type for ovarian cancer [20], and by subsite for colorectal cancer [33]. …”

Section: Resultsmentioning

confidence: 99%

Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival?

Müller

Walters

Coleman

et al. 2018

Cancer Epidemiology

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Rurality and Other Determinants of Early Colorectal Cancer Diagnosis in Nebraska: A 6‐Year Cancer Registry Study, 1998‐2003

Abstract: Early CRC diagnosis needs to be increased in rural (non-core) non-metropolitan residents, unmarried residents, and those with private insurance.

Cited by 22 publications

References 24 publications

Does Patient Rurality Predict Quality Colon Cancer Care?

Does Patient Rurality Predict Quality Colon Cancer Care?

Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study

Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival?

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