Survival of cancer patients in urban and rural areas of Germany—A comparison

Nennecke, Alice; Geiss, Karla; Hentschel, Stefan; Vettorazzi, Eik; Jansen, Lina; Eberle, Andrea; Holleczek, Bernd; Gondos, Ádám; Brenner, Hermann

doi:10.1016/j.canep.2014.02.011

Cited by 34 publications

(47 citation statements)

References 31 publications

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“…Regional variations in cancer survival have also been observed in several studies, with the largest variations observed for prostate and/or breast cancer, in keeping with this study. To what extent adjustment for the prognostic factors under study explained the observed regional variations in cancer survival is ambiguous.…”

Section: Discussionsupporting

confidence: 91%

“…Kravdal showed that failure to include SES‐factors (education) in the reference group without cancer would result in overestimation of the effect of higher education. While some studies have been able to develop SES‐specific life tables, most studies continue to rely upon nationwide or region‐specific life tables . Norway has smaller differences in SES than many other countries, for instance the United States, thus using SES‐specific life tables are less important in Norway.…”

Section: Discussionmentioning

confidence: 99%

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Regional variations in cancer survival: Impact of tumour stage, socioeconomic status, comorbidity and type of treatment in Norway

et al. 2016

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Cancer survival varies by place of residence, but it remains uncertain whether this reflects differences in tumour, patient and treatment characteristics (including tumour stage, indicators of socioeconomic status (SES), comorbidity and information on received surgery and radiotherapy) or possibly regional differences in the quality of delivered health care. National population-based data from the Cancer Registry of Norway were used to identify cancer patients diagnosed in 2002-2011 (n 5 258,675). We investigated survival from any type of cancer (all cancer sites combined), as well as for the six most common cancers. The effect of adjusting for prognostic factors on regional variations in cancer survival was examined by calculating the mean deviation, defined by the mean absolute deviation of the relative excess risks across health services regions. For prostate cancer, the mean deviation across regions was 1.78 when adjusting for age and sex only, but decreased to 1.27 after further adjustment for tumour stage. For breast cancer, the corresponding mean deviations were 1.34 and 1.27. Additional adjustment for other prognostic factors did not materially change the regional variation in any of the other sites. Adjustment for tumour stage explained most of the regional variations in prostate cancer survival, but had little impact for other sites. Unexplained regional variations after adjusting for tumour stage, SES indicators, comorbidity and type of treatment in Norway may be related to regional inequalities in the quality of cancer care.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Regional variations in cancer survival: Impact of tumour stage, socioeconomic status, comorbidity and type of treatment in Norway

et al. 2016

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“…A review conducted in 1992 of patterns of cancer mortality and survival in rural and urban regions suggested that residents of rural areas were more likely to be diagnosed at advanced stage compared with those living in urban communities . Some studies have proposed that people in rural areas have limited access to diagnostic and treatment services . A more recent systematic review found that rural patients had worse prognosis and quality of life; travel distance was reported as a significant barrier to early diagnosis, receiving optimal cancer treatment and compliance to prescribed treatment …”

Section: Introductionmentioning

confidence: 99%

Rural–urban residence and cancer survival in high‐income countries: A systematic review

Afshar

English

Milne

2019

Cancer

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There is some evidence that place of residence is associated with cancer survival, but the findings are inconsistent, and the underlying mechanisms by which residential location might affect survival are not well understood. We conducted a systematic review of observational studies investigating the association of rural versus urban residence with cancer survival in high‐income countries. We searched the Ovid Medline, EMBASE, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases up to May 31, 2016. Forty‐five studies published between 1984 and 2016 were included. We extracted unadjusted and adjusted relative risk estimates with the corresponding 95% confidence intervals. Most studies reported worse survival for cancer patients living in rural areas than those in urban regions. The most consistent evidence, observed across several studies, was for colorectal, lung, and prostate cancer. Of the included studies, 18 did not account for socio‐economic position. Lower survival for more disadvantaged patients is well documented; therefore, it could be beneficial for future research to take socio‐economic factors into consideration when assessing rural/urban differences in cancer survival. Some studies cited differential stage at diagnosis and treatment modalities as major contributing factors to regional inequalities in cancer survival. Further research is needed to disentangle the mediating effects of these factors, which may help to establish effective interventions to improve survival for patients living outside major cities.

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“…More generally, it is likely that the characteristics of the communities in which breast cancer survivors live can have an effect on their survivorship outcomes; women who live in rural and urban areas may have different supportive care needs (because of differences in availability of services for example) and this may translate into differences in QoL. Research has revealed evidence of significant disparities in clinical aspects of breast cancer by area of residence with more advanced stage at diagnosis, lower treatment utilisation, poorer survival and higher mortality in women resident in rural areas [14,15,16]. However, evidence in the area of breast cancer survivorship is limited and findings are inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Urban–Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy

Cahir

Thomas

Dombrowski

et al. 2017

IJERPH

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The number of breast cancer survivors has increased as a result of rising incidence and increased survival. Research has revealed significant urban–rural variation in clinical aspects of breast cancer but evidence in the area of survivorship is limited. We aimed to investigate whether quality of life (QoL) and treatment-related symptoms vary between urban and rural breast cancer survivors prescribed endocrine therapy. Women with a diagnosis of stages I–III breast cancer prescribed endocrine therapy were identified from the National Cancer Registry Ireland and invited to complete a postal survey (N = 1606; response rate = 66%). A composite measure of urban–rural classification was created using settlement size, population density and proximity to treatment hospital. QoL was measured using the Functional Assessment of Cancer Therapy (FACT-G) and an endocrine subscale. The association between urban–rural residence/status and QoL and endocrine symptoms was assessed using linear regression with adjustment for socio-demographic and clinical covariates. In multivariable analysis, rural survivors had a statistically significant higher overall QoL (β = 3.81, standard error (SE) 1.30, p < 0.01), emotional QoL (β = 0.70, SE 0.21, p < 0.01) and experienced a lower symptom burden (β = 1.76, SE 0.65, p < 0.01) than urban survivors. QoL in breast cancer survivors is not simply about proximity and access to healthcare services but may include individual and community level psychosocial factors.

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Survival of cancer patients in urban and rural areas of Germany—A comparison

Cited by 34 publications

References 31 publications

Regional variations in cancer survival: Impact of tumour stage, socioeconomic status, comorbidity and type of treatment in Norway

Regional variations in cancer survival: Impact of tumour stage, socioeconomic status, comorbidity and type of treatment in Norway

Rural–urban residence and cancer survival in high‐income countries: A systematic review

Urban–Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy

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