Association of Rural Residence and Receipt of Guideline-Concordant Care for Locoregional Colon Cancer

• Published in: Annals of surgical oncology 2023-06, Vol.30 (6), p.3538-3546
• Main Authors: Honaker, Michael D., Irish, William, Parikh, Alexander A., Snyder, Rebecca A.
• Format: Article
• Language: English
• Subjects: Aged; Chemotherapy; Colon cancer; Colonic Neoplasms - therapy; Colorectal Cancer; Health Services Accessibility; Humans; Income; Medicare; Medicine; Medicine & Public Health; Oncology; Population studies; Rural Population; Rural populations; Surgery; Surgical Oncology; United States - epidemiology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-023-13340-7

Background Incidence and mortality rates of colon cancer (CC) are higher in rural populations. This study aimed to determine whether rural residence is associated with differences in guideline-concordant care for patients with locoregional CC. Methods Patients with stages I–III CC from 2006 to 2016 were identified in the National Cancer Database. Guideline-concordant care (GCC) was defined as resection with negative margins, adequate nodal harvest, and receipt of adjuvant chemotherapy for patients with high-risk stage II or III disease. Multivariable logistic regression (MVR) was performed to evaluate the association between rural residence and the odds of receiving GCC. Effect modification was evaluated using a two-way interaction for rurality by insurance status. Results Of 320,719 identified patients, 6191 (2%) were rural. The rural patients had lower income and lower educational status than the urban patients and were more often Medicare-insured ( p < 0.001). The rural patients traveled farther (44.5 vs. 7.5 miles; p < 0.001), although time to surgery was similar (8 vs. 9 days). The two cohorts had similar resection rates (98.8% vs. 98.0%), margin positivity (5.4% vs. 4.8%), adequate lymphadenectomy (80.9% vs. 83.0%), adjuvant chemotherapy (stage III: 69.2% vs. 68.7%), and receipt of GCC (66.5% vs. 68.3%). In the MVR, the odds of receiving GCC did not differ between the rural and urban patients (odds ratio, 0.99; 95% confidence interval, 0.94–1.05%). Insurance status did not differentially influence the receipt of GCC by the rural versus the urban patients (interaction: p = 0.83). Conclusions Rural and urban patients with locoregional CC are equally likely to receive GCC, suggesting that differences in cancer care delivery may not explain rural-urban disparities.