Abstract
Introduction: Overall colon cancer outcomes have improved over the last 2 decades. However, optimal outcomes may not be achieved in rural regions. We sought to define whether travel distance from the treating facility as a surrogate marker of rurality impacts colon cancer outcomes. Methods: Patients diagnosed with colon cancer from 2013 to 2017 were analyzed using the National Cancer Database. Multivariate logistic regression, proportional odds regression, multiple regression, and cox regression were used to evaluate for clinically significant associations. Results: A total of 356,189 patients met inclusion criteria. 49.5% were men. 29.7% presented as Stage I, 35.5% as Stage IV. 82.6% of patients lived within 24 miles of the treating facility with 10.1% 25-50 miles. When controlling for race, education status, insurance status, comorbidities, and income, distance was a significant predictor of stage at presentation with more advanced clinical TNM stage as distance increased (adjusted odds ratios 1.25-1.62, p < 0.001 for all distance groups). Similarly, further distance significantly increased the time to surgery, (between 5.10-14.50days, p < 0.001 for all parameters) and overall mortality (hazard ratio 1.11-1.28, p < 0.001 for all distance groups). The median survival was 82.4months for the closest group, vs 75.1months for the farthest group. Conclusion: Increased distance from the treating facility resulted in a significantly higher stage at presentation, increased time to surgery, and increased mortality. These results suggest that significant disparities remain for access to cancer care for patients that live in rural areas. Targeted intervention by treating facilities is needed to improve screening and timely treatment for rural colon cancer patients.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call