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Rural–urban differences in surgical treatment, regional lymph node examination, and survival in endometrial cancer patients

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Abstract

Purpose

Endometrial cancer (EC) is the most common gynecological malignancy and one of few cancers with an increasing US mortality rate. Rural patients may have less access to specialty care affecting their receipt of surgery and adequate lymphadenectomy (AL). We sought to assess rural–urban differences in EC surgery, lymphadenectomy, and survival.

Methods

We analyzed data from the Surveillance Epidemiology and End Results database on EC patients (2004–2013). We performed univariate analyses to compare rural and urban patients on demographic and clinical characteristics and receipt of nodal examination and AL. We assessed rural–urban differences in trends of receipt of AL, performed logistic regression to evaluate differences in receipt of surgery, nodal examination, and AL, and performed survival analysis.

Results

Rural patients were less likely to have any lymph nodes removed, had a smaller median number removed, and a smaller proportion had AL. Even after controlling for established risk factors, rural patients had lower odds of lymph node examination and adequate AL than urban patients and also had poorer survival.

Conclusions

Future research should continue to assess the association between access to care and disparities in surgical care and the effect of these disparities on survival.

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Acknowledgments

Research reported in this manuscript was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under Award Numbers P20CA192987 (Dr. Laurent Brard) and P20CA192966 (Ms. Sonya Izadi and Dr. Graham Colditz).

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Authors and Affiliations

  1. Office of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison St Rm. 235, PO Box 19664, Springfield, IL, 62794-9664, USA

    Whitney E. Zahnd

  2. Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL, USA

    Katherine S. Hyon, Paula Diaz-Sylvester & Laurent Brard

  3. Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA

    Paula Diaz-Sylvester

  4. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Sonya R. Izadi & Graham A. Colditz

  5. Simmons Cancer Institute at SIU, Springfield, IL, USA

    Laurent Brard

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  1. Whitney E. Zahnd
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  2. Katherine S. Hyon
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  3. Paula Diaz-Sylvester
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  4. Sonya R. Izadi
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  6. Laurent Brard
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Corresponding author

Correspondence to Whitney E. Zahnd.

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Conflict of interest

Dr. Brard reports grants from NIH/NCI, during the conduct of the study.

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Zahnd, W.E., Hyon, K.S., Diaz-Sylvester, P. et al. Rural–urban differences in surgical treatment, regional lymph node examination, and survival in endometrial cancer patients. Cancer Causes Control 29, 221–232 (2018). https://doi.org/10.1007/s10552-017-0998-4

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  • DOI: https://doi.org/10.1007/s10552-017-0998-4

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