Rural-urban disparities in Geriatric Assessment (GA) impairments and mortality among older adults with cancer: Results from the Cancer and Aging Resilience Evaluation (CARE) Registry.

Abstract

12012 Background: Rural-urban disparities persist in cancer incidence and mortality, despite improvement in cancer screening and treatment. Older adults are at increased risk for cancer, represent the majority of cancer cases, and are more likely to reside in rural areas than younger adults are. GAs are recommended in clinical management of older adults with cancer, in part to identify aging-related impairments predictive of adverse outcomes; few studies have explored rural-urban disparities in GA impairments and mortality among older patients with cancer. Methods: We included 937 older adults (≥60y) from the CARE registry recently diagnosed with cancer who underwent GA at their first pre-chemotherapy visit to the UAB oncology clinic. Rural-urban status using Rural-Urban Commuting Area (RUCA) codes, classified the cohort by residence in metropolitan, micropolitan, and rural/small town areas. We included self-rated performance status (PS) (≥2 on Eastern Cooperative Oncology Group PS), instrumental activities of daily living (IADL) [≥1 impairment], physical and mental health-related quality of life (HRQoL) [t-score < 40 on PROMIS 10-item Global Health], and overall survival as outcomes. Logistic regression evaluated the association between rural-urban status and each outcome (except overall survival, where we used Cox regression analyses). Micropolitan residence was chosen as the reference category due to similar high risk in both rural and urban areas. Results: Median age at study participation was 69.0y (Interquartile range: 64.0-74.0); 12.4% resided in rural, 14.8% in micropolitan and 72.8% in urban areas; 22.5% were diagnosed with colorectal cancer, 19.0% with pancreatic, and 12.4% with hepatobiliary; 74.7% were Stage III/IV. Participants in rural areas were more likely to be white and less educated. After adjustment for age, sex, race, education and cancer type/stage, rural residence was associated with increased odds of impaired PS (OR = 1.93, 95% CI: 1.10-3.40), limitations in IADLs (OR = 1.79, 95% CI: 1.03-3.10), and impaired physical HRQoL (OR = 1.84, 95% CI: 1.05-3.22) compared to micropolitan residence. Urban residence was not significantly associated with any GA outcomes compared to micropolitan residence. Rural residence was associated with higher hazard of death compared to micropolitan residence (HR = 1.88, 95% CI: 1.09-3.24) as well as urban residence (HR = 1.67, 95% CI: 1.13-2.45). Conclusions: Among older adults with newly diagnosed cancer, rural residence was associated with impaired PS, limitations in IADLs, impaired physical HRQoL, and reduced overall survival. Implementation of routine GA among older adults in rural areas may aid in early identification and intervention on GA impairments to improve cancer outcomes.