Does patient rurality predict quality colon cancer care? A population-based study

Christopher J. Chow, Waddah B. Al-Refaie, Anasooya Abraham, Abraham Markin, Wei Zhong, David A. Rothenberger, Mary R. Kwaan, Elizabeth B Habermann

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: More than 50 million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized, despite its known impact on screening. OBJECTIVE: Our study sought to examine the impact of patient rurality on quality and comprehensive colon cancer care. DESIGN: We constructed a retrospective cohort of 123,129 patients with stage 0 to IV colon cancer. Rural residence was established based on the patient medical service study area designated by the registry. SETTINGS: The study was conducted using the 1996-2008 California Cancer Registry. PATIENTS: All of the patients diagnosed between 1996 and 2008 with tumors located in the colon were eligible for inclusion in this study. MAIN OUTCOME MEASURES: Baseline characteristics were compared by rurality status. Multivariate regression models then were used to examine the impact of rurality on stage in the entire cohort, adequate lymphadenectomy in stage I to III disease, and receipt of chemotherapy for stage III disease. Proportional-hazards regression was used to examine the impact of rurality on cancer-specific survival. RESULTS: Of all of the patients diagnosed with colon cancer, 18,735 (15%) resided in rural areas. Our multivariate models demonstrate that rurality was associated with later stage of diagnosis, inadequate lymphadenectomy in stage I to III disease, and lower likelihood of receiving chemotherapy for stage III disease. In addition, rurality was associated with worse cancer-specific survival. LIMITATIONS: We could not account for socioeconomic status directly, although we used insurance status as a surrogate. Furthermore, we did not have access to treatment location or distance traveled. We also could not account for provider or hospital case volume, patient comorbidities, or complications. CONCLUSIONS: A significant portion of patients treated for colon cancer live in rural areas. Yet, rural residence is associated with modest differences in stage, adherence to quality measures, and survival. Future endeavors should help improve care to this vulnerable population (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A143).

Original languageEnglish (US)
Pages (from-to)415-422
Number of pages8
JournalDiseases of the Colon and Rectum
Volume58
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Colonic Neoplasms
Population
Lymph Node Excision
Survival
Registries
Neoplasms
Drug Therapy
Insurance Coverage
Delayed Diagnosis
Vulnerable Populations
Social Class
Comorbidity
Colon

Keywords

  • Cancer-specific survival
  • Chemotherapy
  • Colon cancer
  • Lymphadenectomy, outcomes, rurality

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Does patient rurality predict quality colon cancer care? A population-based study. / Chow, Christopher J.; Al-Refaie, Waddah B.; Abraham, Anasooya; Markin, Abraham; Zhong, Wei; Rothenberger, David A.; Kwaan, Mary R.; Habermann, Elizabeth B.

In: Diseases of the Colon and Rectum, Vol. 58, No. 4, 01.04.2015, p. 415-422.

Research output: Contribution to journalArticle

Chow, CJ, Al-Refaie, WB, Abraham, A, Markin, A, Zhong, W, Rothenberger, DA, Kwaan, MR & Habermann, EB 2015, 'Does patient rurality predict quality colon cancer care? A population-based study', Diseases of the Colon and Rectum, vol. 58, no. 4, pp. 415-422. https://doi.org/10.1097/DCR.0000000000000173
Chow CJ, Al-Refaie WB, Abraham A, Markin A, Zhong W, Rothenberger DA et al. Does patient rurality predict quality colon cancer care? A population-based study. Diseases of the Colon and Rectum. 2015 Apr 1;58(4):415-422. https://doi.org/10.1097/DCR.0000000000000173
Chow, Christopher J. ; Al-Refaie, Waddah B. ; Abraham, Anasooya ; Markin, Abraham ; Zhong, Wei ; Rothenberger, David A. ; Kwaan, Mary R. ; Habermann, Elizabeth B. / Does patient rurality predict quality colon cancer care? A population-based study. In: Diseases of the Colon and Rectum. 2015 ; Vol. 58, No. 4. pp. 415-422.
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