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Disparity of Colon Cancer Outcomes in Rural America: Making the Case to Travel the Extra Mile

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Objectives

Rural patients experience disparities in cancer care compared to urban patients. We hypothesized that rural patients with colon cancer who traveled to high-volume centers for treatment have similar survival compared to urban patients who also traveled to high-volume centers to seek treatment for colon cancer.

Methods

The National Cancer Database was interrogated for patients treated for stage I–III colon cancer (2004–2015). Travel distance to treatment centers and annual hospital volume were divided into quartiles. Two groups of patients were identified and compared: (1) rural patients who traveled to high-volume hospitals and (2) urban patients who also traveled to high-volume centers. The primary outcome was overall survival (OS).

Results

Of 647,949 patients, 634, 447 were urban and 13,502 were rural. Rural patients were more likely to be Caucasian, with lower income, more comorbidities, and be treated at non-academic centers. In multivariable analysis, rural patients had worse OS compared to urban patients (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.04–1.12; p = < 0.001). There were 46,781 (7%) urban patients and 1276 (9%) rural patients who traveled a long distance (median 40 and 108 miles, respectively) to high-volume centers. There was no difference in adjusted OS between urban and rural patients who traveled to high-volume centers for treatment (HR 1.06; 95%CI 0.94–1.20; p = 0.36).

Conclusions

This nationwide analysis suggests that rural patients with colon cancer experience worse survival than urban patients, but that this disparity might be mitigated by rural patients traveling to high-volume centers for treatment.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3443, Durham, NC, 27710, USA

    Vignesh Raman, Megan C. Turner, Harvey G. Moore, Christopher R. Mantyh & John Migaly

  2. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Mohamed A. Adam

Authors
  1. Vignesh Raman
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  2. Mohamed A. Adam
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  3. Megan C. Turner
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  4. Harvey G. Moore
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  5. Christopher R. Mantyh
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  6. John Migaly
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Contributions

Study design (MAA, MCT, JM); data acquisition (VR, MAA, MCT); interpretation (all authors); drafting manuscript (all authors); final approval (all authors); responsibility for the accuracy and integrity of the work (all authors).

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Correspondence to Vignesh Raman.

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Raman, V., Adam, M.A., Turner, M.C. et al. Disparity of Colon Cancer Outcomes in Rural America: Making the Case to Travel the Extra Mile. J Gastrointest Surg 23, 2285–2293 (2019). https://doi.org/10.1007/s11605-019-04270-5

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  • DOI: https://doi.org/10.1007/s11605-019-04270-5

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