Evaluating the urban-rural paradox: The complicated relationship between distance and the receipt of guideline-concordant care among cervical cancer patients.
Cervical cancer patients
Disparities
Distance to care
Guideline-concordant care
Urban/rural
Journal
Gynecologic oncology
ISSN: 1095-6859
Titre abrégé: Gynecol Oncol
Pays: United States
ID NLM: 0365304
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
27
08
2018
revised:
31
10
2018
accepted:
06
11
2018
pubmed:
18
11
2018
medline:
5
2
2019
entrez:
17
11
2018
Statut:
ppublish
Résumé
Urban-rural health disparities are often attributed to the longer distances rural patients travel to receive care. However, a recent study suggests that distance to care may affect urban and rural cancer patients differentially. We examined whether this urban-rural paradox exists among patients with cervical cancer. We identified individuals diagnosed with cervical cancer from 2004 to 2013 using a statewide cancer registry linked to multi-payer, insurance claims. Our primary outcome was receipt of guideline-concordant care: surgery for stages IA1-IB1; external beam radiation therapy (EBRT), concomitant chemotherapy, and brachytherapy for stages IB2-IVA. We estimated risk ratios (RR) using modified Poisson regressions, stratified by urban/rural location, to examine the association between distance to nearest facility and receipt of treatment. 62% of 999 cervical cancer patients received guideline-concordant care. The association between distance and receipt of care differed by type of treatment. In urban areas, cancer patients who lived ≥15 miles from the nearest surgical facility were less likely to receive primary surgical management compared to those <5 miles from the nearest surgical facility (RR: 0.77, 95% CI: 0.60-0.98). In rural areas, patients living ≥15 miles from the nearest brachytherapy facility were more likely to receive treatment compared to those <5 miles from the nearest brachytherapy facility (RR: 1.71, 95% CI: 1.14-2.58). Distance was not associated with the receipt of chemotherapy or EBRT. Among cervical cancer patients, there is evidence supporting the urban-rural paradox, i.e., geographic distance to cancer care facilities is not consistently associated with treatment receipt in expected or consistent ways. Healthcare systems must consider the diverse and differential barriers encountered by urban and rural residents to improve access to high quality cancer care.
Identifiants
pubmed: 30442384
pii: S0090-8258(18)31407-0
doi: 10.1016/j.ygyno.2018.11.010
pmc: PMC6321781
mid: NIHMS1512368
pii:
doi:
Types de publication
Evaluation Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
112-118Subventions
Organisme : NCI NIH HHS
ID : T32 CA116339
Pays : United States
Organisme : AHRQ HHS
ID : T32 HS000032
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002489
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
Références
J Clin Oncol. 2012 Jan 10;30(2):142-50
pubmed: 22147735
JAMA. 2016 Dec 13;316(22):2385-2401
pubmed: 27959996
J Oncol Pract. 2014 Sep;10(5):e313-20
pubmed: 25052498
JAMA. 2017 Jan 24;317(4):388-406
pubmed: 28118455
Int J Radiat Oncol Biol Phys. 2013 Apr 1;85(5):1157-8
pubmed: 23391815
Health Place. 2014 Sep;29:114-23
pubmed: 25063908
Cancer Epidemiol Biomarkers Prev. 2013 Oct;22(10):1657-67
pubmed: 24097195
Am J Epidemiol. 2004 Apr 1;159(7):702-6
pubmed: 15033648
Int J Radiat Oncol Biol Phys. 2015 Jun 1;92(2):260-7
pubmed: 25968823
J Natl Cancer Inst. 2003 Sep 17;95(18):1370-5
pubmed: 13130112
J Clin Oncol. 1987 Oct;5(10):1640-5
pubmed: 3655862
JAMA. 1994 Jun 22-29;271(24):1931-3
pubmed: 8201737
Cancer. 2012 Oct 15;118(20):5110-6
pubmed: 22707306
Curr Probl Cancer. 2007 May-Jun;31(3):157-81
pubmed: 17543946
J Gastrointest Oncol. 2016 Jun;7(3):336-44
pubmed: 27284464
Gynecol Oncol. 2018 Jul;150(1):73-78
pubmed: 29709291
J Rural Health. 2005 Winter;21(1):31-8
pubmed: 15667007
Gynecol Oncol. 2018 Apr;149(1):4-11
pubmed: 29605048
J Clin Oncol. 2013 Oct 1;31(28):3579-84
pubmed: 24002515
Gynecol Oncol. 2006 Nov;103(2):547-53
pubmed: 16730784
Int J Nurs Pract. 2003 Jun;9(3):176-82
pubmed: 12801249
J Immigr Minor Health. 2012 Apr;14(2):350-5
pubmed: 22512007
J Natl Cancer Inst. 2005 Feb 2;97(3):219-25
pubmed: 15687365
Obstet Gynecol. 2018 May;131(5):899-908
pubmed: 29630020
BMC Health Serv Res. 2007 Mar 09;7:40
pubmed: 17349050
N C Med J. 2014 Jul-Aug;75(4):265-9
pubmed: 25046092
Support Care Cancer. 2016 Mar;24(3):1167-74
pubmed: 26275767
Cancer. 2004 Sep 1;101(5):1051-7
pubmed: 15329915
Am J Public Health. 2001 Mar;91(3):392-9
pubmed: 11236403
Am J Clin Oncol. 2016 Feb;39(1):55-63
pubmed: 24390274
Health Place. 2014 Jul;28:92-8
pubmed: 24793139
Gynecol Oncol. 2015 Dec;139(3):500-5
pubmed: 26498912
N C Med J. 2014 Jul-Aug;75(4):239-46
pubmed: 25046086
JAMA. 1998 Nov 18;280(19):1690-1
pubmed: 9832001