Outcome disparities in rural versus urban patients with head and neck cancer: Leveling the playing field.

Abstract

e18529 Background: Multiple studies indicate that rural patients experience disproportionately adverse cancer related outcomes, compared to their urban counterparts. This has been attributed to inequities in access to healthcare, monetary and technological resources, disease characteristics, adverse health status and lower life expectancy of rural populace. Whether treating patients with uniform protocols can help mitigate outcome disparities remains to be determined. Methods: We conducted a retrospective cohort study to evaluate survival outcomes of Head-Neck Squamous Cell Cancer (HNSCC) patients from rural versus urban locales. Only patients with locally advanced HNSCC who completed radiotherapy (RT) at the Emily Couric Clinical Cancer Center were included. Rural patients had access to affordable lodging for the duration of radiotherapy (RT), were treated regardless of health insurance status and by the same multidisciplinary team. Patients with distant metastases were excluded. Patients were classified as urban or rural using the Rural-Urban Commuting Areas (RUCA) zip-code database. Overall survival (OS) was analyzed using Kaplan-Meier curves and log-rank test. OS was modeled with a COX proportional hazards model, adjusting for several covariates including race, age, gender, HPV status, smoking, treatment received (RT, chemotherapy, surgery) and stage. Results: 230 patients with Stage I-IVB HNSCC who met the inclusion criteria were analyzed, of which 136 were categorized as residentially urban and 94 were categorized as rural. Approximately 83% were male, 87% were Caucasian and 71% were smokers (52% current smokers and 19% former smokers). In addition to RT, 42% patients had undergone surgery and 57% received chemotherapy. There was no statistically significant difference in OS for patients residing in rural vs urban zip-codes (HR 1.36, p = 0.24). Rural patients were less likely to undergo surgery (34% vs 44%, p = 0.04), and more likely to receive chemotherapy (67% vs 54%, p = 0.0325), likely indicating more advanced tumor stage at diagnosis. Conclusions: Rural and urban patients had similar OS when treated with similar treatment protocols. Improving access to uniform treatment regimens may help mitigate the widening gap in cancer-related outcomes between rural and urban populations.