Disparities in screening, diagnosis, treatment, and survivorship care among urban and rural patients with colorectal cancer in the United States: A systematic review and meta-analysis.

Abstract

e18558 Background: Older rural patients suffer from disproportionately higher rates of colorectal cancer (CRC) and mortality due to CRC compared to older urban patients. These disparities may be multifactorial including geographic barriers to care, lack of health insurance coverage, or lack of preventive health behaviors, among others. To further understand this burden of rural-urban CRC disparities along the cancer care continuum, we sought to evaluate and synthesize literature on screening, diagnosis, treatment, and survivorship care differences between urban and rural CRC patients. Methods: We performed a systematic literature review using PubMed and EMBASE in August 2022 using keywords related to screening, diagnosis, treatment, and survivorship care for CRC urban-rural patients for studies published in 2000 to 2022. A meta-analysis was performed for results related to screening using a random-effects model. Results: Of 836 studies collected, 46 met criteria for review, and 12 for a meta-analysis evaluating the effect of rurality on any reported CRC screening. The majority of studies evaluated disparities in screening (46%), followed by diagnosis (30%), treatment (20%), and survivorship care (4%). In general, studies indicated urban CRC patients as more likely to report age-appropriate screening, to receive early-stage diagnosis, and to receive timely and appropriate treatment compared to rural CRC patients. Only one study was found evaluating a difference in receipt of surveillance colonoscopy in urban/rural CRC survivors, with rural survivors as 2.28 times more likely to report nonadherence to surveillance screening (OR = 2.28, 95%CI:1.07-4.85). Meta-analysis results indicate that rural patients had 22% lower odds of reporting screening compared to urban patients prior to any diagnosis (pooled OR = 0.78, 95%CI:0.66-0.92, I2= 42.9%). Conclusions: Despite widespread support and effort to implement policy aimed toward reducing disparities of care, screening, diagnosis, and treatment gaps are still present between urban and rural CRC patients. Further research must be performed to evaluate the effects of these disparities on clinical outcomes in the rural CRC patient population.