Examining urban and rural differences in perceived timeliness of care among cancer patients: A SEER-CAHPS study.

Abstract

Rural cancer patients often have challenges in accessing quality care. This study examined associations between the place of residence at cancer diagnosis (urban vs rural) and patient ratings of access to care among older cancer survivors participating in Medicare-managed care. Using Surveillance, Epidemiology, and End Results -Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, which included SEER data and Medicare CAHPS patient experience surveys, this study identified urban (n = 6140) and rural Medicare beneficiaries (n = 686) aged ≥ 65 years with a breast, lung, colorectal, or prostate cancer diagnosis who had completed a Medicare CAHPS survey between 1998 and 2013. Multivariable models examined associations between survivor residence at the time of diagnosis and CAHPS measures of timeliness and ease of getting care. Respondents who resided in urban areas (vs rural) at the time of their cancer diagnosis rated their care significantly lower for Getting Care Quickly (b = -2.27; standard error = 0.95; P = .02). Although there were no overall significant differences for Getting Needed Care, there was a significant interaction between race/ethnicity and residence (P = .04): both non-Hispanic black and Hispanic respondents residing in rural areas rated Getting Needed Care lower than those respondents residing in urban areas. In contrast to prior studies, these findings suggest that rural survivors report more timely care than those in urban areas, but accessing needed care may be more challenging for racial/ethnic minority rural survivors. Future examination of specific barriers for urban and racial/ethnic minority rural survivors is warranted to ensure equitable access to quality cancer care. Cancer 2018. © 2018 American Cancer Society.