Effect of shorter time to treatment on survival in rural patients with breast cancer.

Abstract

7027 Background: Rural cancer care in the United States has unique challenges from variable access to care. This study examined differences in time to first treatment (TTT), a potential surrogate for access, and predictors of overall survival (OS) between rural and non-rural patients with breast cancer. Methods: Women with stage I-III breast cancer from 2004-2012 in the National Cancer Database of Commission on Cancer (CoC)-accredited facilities were included and categorized as rural and non-rural. Differences in demographic, disease and treatment characteristics, socioeconomic factors and TTT (< 4 weeks, 4-8 weeks and > 8 weeks) between rural and non-rural patients were assessed by Chi-square test. The effect of age, insurance status, cancer center type, community median income, community % no high school, and TTT on OS were assessed using univariate and multivariate Cox models. Results: The study included 1,205,031 patients, 18,417 (2%) of whom were rural. Compared to non-rural patients, rural patients were more likely to be age > 65, Caucasian, receive care at non-academic centers, have government insurance, have lower income and less education (p < 0.0001 for all). Significant demographic and socioeconomic differences are shown in Table. Rural patients had shorter mean TTT (3.72 vs. 4.35 weeks, p < 0.0001). More rural patients had TTT < 4 weeks (67% vs. 57%) and < 8 weeks (94% vs. 90%), p < 0.0001 for both. Shorter TTT (both < 4 weeks vs. 8 weeks and 4-8 weeks vs. > 8 weeks) was associated with improved OS (HR: 0.84, 95% CI: 0.82-0.86, p < 0.0001 and HR: 0.82, 95% CI: 0.81-0.83, p < 0.0001, respectively). After adjusting for demographic, socioeconomic, disease stage and treatment factors, rural status was associated with significantly better OS compared to non-rural status (HR: 0.92, 95% CI: 0.89-0.96, p < 0.0001). Conclusions: Despite several adverse socioeconomic factors, rural patients with breast cancer with access to CoC-accredited facilities had significantly shorter TTT and better OS compared to non-rural patients. These data suggest improving TTT can mitigate disparities in rural cancer care. It is unclear whether our data apply to non-CoC-accredited facilities in rural United States. [Table: see text]