Patients in rural areas who received surgery locally for their lung or colon cancer had comparable surgical outcomes and mortality rates to patients who underwent surgery in an urban facility, according to the results of an analysis published in the Journal of the American College of Surgeons.
“[Patients with] cancer in rural areas often have a harder time accessing high-quality, multidisciplinary cancer care,” said first author Michael E. Egger, MD, MPH, FACS, Associate Professor of Surgery, University of Louisville School of Medicine, and past president of the Kentucky Chapter of the American College of Surgeons. “But traveling long distances for surgery is not practical for all patients, nor is it sustainable for high-volume urban facilities already at capacity. To better address health-care disparities in rural communities, we wanted to understand where rural [patients with] cancer seek surgical care and whether receiving it locally or farther away affected their outcomes.”
Study Methods
Researchers explored barriers to cancer care among patients with cancer in rural areas by looking at whether Medicare-aged patients could safely receive surgery for lung or colon cancer at their local rural hospital without having to travel. The study assessed patients from Surveillance, Epidemiology, and End Results (SEER)–Medicare files to find patients with lung cancer (n = 6,006) or stage I to III colon cancer (n = 10,383) receiving elective surgery for cancer who lived outside of a metropolitan area by zip code. They explored files for patients receiving surgery at rural facilities to compare them with those receiving surgery at a higher-volume urban facility according to complication and mortality rates.
Key Findings
No clinically significant differences were found between patients treated in rural or urban facilities according to their demographics, cancer stage, or comorbidity risks.
Mortality and complication rates were also similar between rural and urban facilities. Mortality rates at 90 days were about 5% for patients with lung cancer and about 7% for patients with lung cancer. About 10% of patients with lung cancer required hospital readmission as well as 14% of assessed patients with colon cancer.
Patients with lung cancer and colon cancer both traveled significantly further for surgery at an urban facility than a rural facility: 49 vs 16 miles for patients with colon cancer (P < .001) and 61 vs 36 miles for patients with lung cancer (P < .001). “Long travel times and costs associated with travel can be a significant burden for many [patients with] cancer living in rural communities,” Dr. Egger said. “As hospital systems regionalize care, it is going to be important to determine which patients can receive care more locally and who may benefit from receiving more centralized care.”
Researchers from the American Cancer Society will continue to explore elements of cancer care in rural vs urban facilities. “Surgery is just one important part of a patient’s continuum of care, which may also include chemotherapy, radiation treatment, or other therapies,” Dr. Egger said. “Disparities in cancer treatment may be caused by delays in screening or treatment after surgery. Some of our future research will examine what we can learn from high-performing facilities to improve cancer care for rural patients.”
DISCLOSURE: Dr. Egger reported receiving support from a Clinician Scientist Development grant from the American Cancer Society, and Dr. Kong reported receiving support from a Clinical and Translational Research Developmental grant from the National Institutes of Health. For further disclosures, visit journals.lww.com.
