The impact of rural residence on adult brain cancer survival in the United States

Delavar, Arash Ghorbannia; Jammal, Omar M Al; Maguire, Kathleen R; Wali, Arvin R.; Pham, Martin H.

doi:10.1007/s11060-019-03254-4

Cited by 13 publications

(15 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Worse cancer survival has been reported among adults aged ≥20 years who live in rural versus metro Utah counties 21 and for adults with brain tumors living in the most rural versus the most urban areas 22 . Other studies have not found an association between rural residence and cancer survival for ovarian 23 and head and neck cancer 24 …”

Section: Discussionmentioning

confidence: 99%

Associations between geographic residence and US adolescent and young adult cancer stage and survival

Johnson

Wang

Barnes

et al. 2021

Cancer

Self Cite

View full text Add to dashboard Cite

Background Multiple studies have indicated that place of residence can influence cancer survival; however, few studies have specifically focused on geographic factors and outcomes in adolescents and young adults (AYAs) with cancer. The objective of this study was to evaluate evidence for geographic disparities in cancer diagnosis stage and overall survival in AYAs and to examine whether stage mediated survival associations. Methods National Cancer Database data on AYAs aged 15 to 39 years who were diagnosed with cancer from 2010 to 2014 were obtained. Residence in Metropolitan (metro), urban, or rural counties at the time of diagnosis was defined using Rural‐Urban Continuum Codes. Distance between the patient's residence and the reporting hospital was classified as short (≤2.5 miles), intermediate (>12.5 to <50 miles), or long (≥50 miles). Logistic and Cox proportional hazards regression models were used for analyses. Results The stage and survival analyses included 146,418 and 178,688 AYAs, respectively. The odds of a late versus early stage at diagnosis (stages III and IV vs I and II) were 1.16 (95% CI, 1.05‐1.29) times greater for AYAs living in rural versus metro counties and 1.20 (95% CI, 1.16‐1.25) times greater for AYAs living at long versus short distances to the reporting hospital. The hazard of death was 1.17 (95% CI, 1.05‐1.31) and 1.30 (95% CI, 1.25‐1.36) times greater for those living in rural versus metro counties, respectively, and for long versus short distances to the reporting hospital, respectively. Disease stage mediated 54% and 31% of the associations between metro, urban, or rural residence and residential distance categories and survival. Conclusions Rural residence and living long distances from the reporting hospital were associated with later stage diagnoses and lower survival in AYAs with cancer. Further research is needed to understand mechanisms. Lay Summary Adolescents and young adults (AYAs) with cancer are a vulnerable population because cancer is of low suspicion in this population and may not be diagnosed in a timely manner. The authors evaluated evidence for geographic disparities in cancer stage at diagnosis and survival in the AYA population. The findings indicate that AYAs living in rural versus metropolitan US counties and those living farther from the diagnosis reporting hospital are more likely to be diagnosed at a later cancer stage, when it is generally less treatable, and have lower survival compared with AYAs living in metropolitan counties.

show abstract

Section: Discussionmentioning

confidence: 99%

Associations between geographic residence and US adolescent and young adult cancer stage and survival

Johnson

Wang

Barnes

et al. 2021

Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…Most large cancer centers capable of managing CNS tumors with experienced multidisciplinary teams are located in urban areas. As such, those living in rural areas may have more difficulty accessing these centers, along with more sophisticated therapies 11 …”

Section: Discussionmentioning

confidence: 99%

“…As such, those living in rural areas may have more difficulty accessing these centers, along with more sophisticated therapies. 11 When evaluating different age groups, the youngest age group from the lowest SES level was not found to have a statistically significant increased mortality hazard. However, within the older age groups, those with the lowest SES did have an association with an increased hazard of death.…”

Section: Census Classification Urbanmentioning

confidence: 93%

“…6 AYA patients living in rural areas, older AYA patients, and those from lower SES have been found to have decreased access to National Cancer Institute (NCI) centers-a factor that has been shown to contribute to inferior outcomes amongst AYA oncology patients. [10][11][12][13] As AYA patients face challenges in receiving appropriate care, it becomes imperative to understand the impact of disparities on survival within the AYA neuro-oncology population.…”

Section: Introductionmentioning

confidence: 99%

“…Another study looking at the AYA population within the California Cancer Registry noted that while overall survival in the AYA cancer population has improved in recent decades, there have also been growing survival disparities among AYA patients with cancer from racial/ethnic minorities and lower SES 6 . AYA patients living in rural areas, older AYA patients, and those from lower SES have been found to have decreased access to National Cancer Institute (NCI) centers—a factor that has been shown to contribute to inferior outcomes amongst AYA oncology patients 10–13 . As AYA patients face challenges in receiving appropriate care, it becomes imperative to understand the impact of disparities on survival within the AYA neuro‐oncology population.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Racial/ethnic, socioeconomic, and geographic survival disparities in adolescents and young adults with primary central nervous system tumors

Puthenpura

Canavan²,

Poynter

et al. 2021

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Background: Disparities in survival by race/ethnicity, socioeconomic status (SES), and geography in adolescent and young adult (AYA) patients with central nervous system (CNS) tumors have not been well studied.Procedure: A retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER) database was conducted for AYA patients diagnosed with primary CNS tumors. Adjusted hazard ratios (aHR) were calculated using a multivariate Cox proportional hazard model to evaluate the association between race/ethnicity, SES, rurality, and hazard of death.Results: All minority groups showed an increased hazard of death with greatest disparities in the high-grade glioma cohort. Lower SES was associated with an increased hazard of death in non-Hispanic White (NHW) patients (aHR 1.12; 95% confidence interval [CI] 1.01-1.24), non-Hispanic Black (NHB) patients (aHR 1.34; 95% CI 1.00-1.80), and patients aged 25-29 years (aHR 1.29; 95% CI 1.07-1.55). Mediation analysis showed an indirect effect of SES on the effect of race/ethnicity on the hazard of death only among NHB patients, with SES accounting for 33.7% of the association between NHB and hazard of death. Rurality was associated with an increased hazard of death for patients in the lowest SES tertile (aHR 1.31; 95% CI 1.08-1.59) and NHW patients (aHR 1.20; 95% CI 1.08-1.34). Conclusions:Patients identified as a racial/ethnic minority, patients with a lower SES, and patients residing in rural areas had an increased hazard of death. Further studies are needed to understand and address the biological, psychosocial, societal, and economic factors that impact AYA neuro-oncology patients at highest risk of experiencing poorer outcomes.

show abstract

Racial and socioeconomic disparities in glioblastoma outcomes: A single‐center, retrospective cohort study

Estevez‐Ordonez,

Abdelrashid,

Coffee

et al. 2023

Cancer

View full text Add to dashboard Cite

BackgroundGlioblastoma (GBM) is the most common malignant primary brain tumor. Emerging reports have suggested that racial and socioeconomic disparities influence the outcomes of patients with GBM. No studies to date have investigated these disparities controlling for isocitrate dehydrogenase (IDH) mutation and O‐6‐methylguanine‐DNA methyltransferase (MGMT) status.MethodsAdult patients with GBM were retrospectively reviewed at a single institution from 2008 to 2019. Univariable and multivariable complete survival analyses were performed. A Cox proportional hazards model was used to assess the effect of race and socioeconomic status controlling for a priori selected variables with known relevance to survival.ResultsIn total, 995 patients met inclusion criteria. Of these, 117 patients (11.7%) were African American (AA). The median overall survival for the entire cohort was 14.23 months. In the multivariable model, AA patients had better survival compared with White patients (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.2–0.69). The observed survival difference was significant in both a complete case analysis model and a multiple imputations model accounting for missing molecular data and controlling for treatment and socioeconomic status. AA patients with low income (HR, 2.17; 95% CI, 1.04–4.50), public insurance (HR, 2.25; 95% CI, 1.04–4.87), or no insurance (HR, 15.63; 95% CI, 2.72–89.67) had worse survival compared with White patients with low income, public insurance, or no insurance, respectively.ConclusionsSignificant racial and socioeconomic disparities were identified after controlling for treatment, GBM genetic profile, and other variables associated with survival. Overall, AA patients demonstrated better survival. These findings may suggest the possibility of a protective genetic advantage in AA patients.Plain Language Summary To best personalize treatment for and understand the causes of glioblastoma, racial and socioeconomic influences must be examined. The authors report their experience at the O’Neal Comprehensive Cancer Center in the deep south. In this report, contemporary molecular diagnostic data are included. The authors conclude that there are significant racial and socioeconomic disparities that influence glioblastoma outcome and that African American patients do better.

show abstract

The impact of rural residence on adult brain cancer survival in the United States

Cited by 13 publications

References 31 publications

Associations between geographic residence and US adolescent and young adult cancer stage and survival

Associations between geographic residence and US adolescent and young adult cancer stage and survival

Racial/ethnic, socioeconomic, and geographic survival disparities in adolescents and young adults with primary central nervous system tumors

Racial and socioeconomic disparities in glioblastoma outcomes: A single‐center, retrospective cohort study

Contact Info

Product

Resources

About