Association Between Rurality and Lung Cancer Treatment Characteristics and Timeliness.
cancer
lung cancer
rurality
timeliness of treatment
treatment delay
Journal
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
ISSN: 1748-0361
Titre abrégé: J Rural Health
Pays: England
ID NLM: 8508122
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
pubmed:
20
2
2019
medline:
23
6
2020
entrez:
20
2
2019
Statut:
ppublish
Résumé
Lung cancer is the leading cause of cancer-related mortality in the United States, and rural states bear a greater burden of disease. We analyzed tumor registry data to examine relationships between rurality and lung cancer stage at diagnosis and treatment. Cases were from the Maine Cancer Registry from 2012 to 2015, and rurality was defined using rural-urban commuting areas. Multivariable models were used to examine the relationships between rurality and treatment, adjusting for age, sex, poverty, education, insurance status, and cancer stage. We identified 5,338 adults with incident lung cancer; 3,429 (64.2%) were diagnosed at a late stage (III or IV). Rurality was not associated with stage at diagnosis. For patients with early-stage disease (I or II), rurality was not associated with receipt of treatment. However, for patients with late-stage disease, residents of large rural areas received more surgery (10%) compared with metropolitan (9%) or small/isolated rural areas (6%), P = .01. In multivariable analyses, patients in large rural areas received more chemotherapy (OR 1.48; 95% CI: 1.08-2.02) than those in metropolitan areas. Patients with early-stage disease residing in small/ isolated rural areas had delays in treatment (median time to first treatment = 43 days, interquartile range [IQR] 22-68) compared with large rural (34 days, IQR 17-55) and metropolitan areas (35 days, IQR 17-60), P = .0009. Rurality is associated with differences in receipt of specific lung cancer treatments and in timeliness of treatment.
Sections du résumé
BACKGROUND
Lung cancer is the leading cause of cancer-related mortality in the United States, and rural states bear a greater burden of disease.
METHODS
We analyzed tumor registry data to examine relationships between rurality and lung cancer stage at diagnosis and treatment. Cases were from the Maine Cancer Registry from 2012 to 2015, and rurality was defined using rural-urban commuting areas. Multivariable models were used to examine the relationships between rurality and treatment, adjusting for age, sex, poverty, education, insurance status, and cancer stage.
RESULTS
We identified 5,338 adults with incident lung cancer; 3,429 (64.2%) were diagnosed at a late stage (III or IV). Rurality was not associated with stage at diagnosis. For patients with early-stage disease (I or II), rurality was not associated with receipt of treatment. However, for patients with late-stage disease, residents of large rural areas received more surgery (10%) compared with metropolitan (9%) or small/isolated rural areas (6%), P = .01. In multivariable analyses, patients in large rural areas received more chemotherapy (OR 1.48; 95% CI: 1.08-2.02) than those in metropolitan areas. Patients with early-stage disease residing in small/ isolated rural areas had delays in treatment (median time to first treatment = 43 days, interquartile range [IQR] 22-68) compared with large rural (34 days, IQR 17-55) and metropolitan areas (35 days, IQR 17-60), P = .0009.
CONCLUSION
Rurality is associated with differences in receipt of specific lung cancer treatments and in timeliness of treatment.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
560-565Informations de copyright
© 2019 National Rural Health Association.
Références
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
Atkins GT, Kim T, Munson J. Residence in rural areas of the united states and lung cancer mortality. Disease incidence, treatment disparities, and stage-specific survival. Ann Am Thorac Soc. 2017;14(3):403-411.
US Census Bureau. Available at: https://www.census.gov/geo/reference/ua/urban-rural-2010.html. Accessed January 26, 2018.
Centers for Disease Control and Prevention and National Cancer Institute USCSWG. United States Cancer Statistics: 1999-2014 Incidence and Mortality Web-based Report. Available at: www.cdc.gov/uscs. Accessed October 15, 2017.
Jenkins WD, Matthews AK, Bailey A, et al. Rural areas are disproportionately impacted by smoking and lung cancer. Prev Med Rep. 2018;10:200-203.
Pleis JR, Ward BW, Lucas JW. Summary health statistics for U.S. adults: National Health Interview Survey, 2009. Vital Health Stat 10. 2010(249):1-207.
Singh GK, Siahpush M, Williams SD. Changing urbanization patterns in US lung cancer mortality, 1950-2007. J Commun Health. 2012;37(2):412-420.
Doogan NJ, Roberts ME, Wewers ME, et al. A growing geographic disparity: rural and urban cigarette smoking trends in the United States. Prev Med. 2017;104:79-85.
Singh GK, Williams SD, Siahpush M, Mulhollen A. Socioeconomic, rural-urban, and racial inequalities in US Cancer Mortality: part i-all cancers and lung cancer and part ii-colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol. 2011;2011:107497.
Shugarman LR, Sorbero ME, Tian H, Jain AK, Ashwood JS. An exploration of urban and rural differences in lung cancer survival among Medicare beneficiaries. Am J Public Health. 2008;98(7):1280-1287.
Olsson JK, Schultz EM, Gould MK. Timeliness of care in patients with lung cancer: a systematic review. Thorax. 2009;64(9):749-756.
United States Department of Agriculture ERS. Rural-urban commuting area codes. Available at: https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/. Accessed January 26, 2018.
Hart LG, Larson EH, Lishner DM. Rural definitions for health policy and research. Am J Public Health. 2005;95(7):1149-1155.
Zahnd WE, Fogleman AJ, Jenkins WD. Rural-urban disparities in stage of diagnosis among cancers with preventive opportunities. Am J Prev Med. 2018;54(5):688-698.
Nadpara PA, Madhavan SS, Tworek C. Disparities in lung cancer care and outcomes among elderly in a medically underserved state population-a cancer registry-linked database study. Popul Health Manag. 2016;19(2):109-119.
Simunovic M, Theriault ME, Paszat L, et al. Using administrative databases to measure waiting times for patients undergoing major cancer surgery in Ontario, 1993-2000. Can J Surg. 2005;48(2):137-142.
Johnson AM, Hines RB, Johnson JA 3rd, Bayakly AR. Treatment and survival disparities in lung cancer: the effect of social environment and place of residence. Lung Cancer. 2014;83(3):401-407.
Onega T, Duell EJ, Shi X, Wang D, Demidenko E, Goodman D. Geographic access to cancer care in the U.S. Cancer. 2008;112(4):909-918.
Onega T, Duell EJ, Shi X, Demidenko E, Goodman D. Determinants of NCI Cancer Center attendance in Medicare patients with lung, breast, colorectal, or prostate cancer. J Gen Intern Med. 2009;24(2):205-210.
Halverson J, Martinez-Donate A, Trentham-Dietz A, et al. Health literacy and urbanicity among cancer patients. J Rural Health. 2013;29(4):392-402.
Lezzoni LI, Ngo LH, Li D, Roetzheim RG, Drews RE, McCarthy EP. Treatment disparities for disabled Medicare beneficiaries with stage I non-small cell lung cancer. Arch Phys Med Rehabil. 2008;89(4):595-601.
Martinez-Donate AP, Halverson J, Simon NJ, et al. Identifying health literacy and health system navigation needs among rural cancer patients: findings from the Rural Oncology Literacy Enhancement Study (ROLES). J Cancer Educ. 2013;28(3):573-581.