Access to cancer services for rural colorectal cancer patients.
BACKGROUND
Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas.


OBJECTIVE
To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.


METHODS
Descriptive cross-sectional study using linked Surveillance, Epidemiology, and End Results (SEER) cancer registry and Medicare claims data for 27,143 individuals ages 66 and older diagnosed with stages I through III CRC between 1992 and 1996.


RESULTS
Over 90% of rural CRC patients lived within 30 miles of a surgical hospital offering CRC surgery, but less than 50% of CRC patients living in small and isolated small rural areas had a medical or radiation oncologist within 30 miles. Rural CRC patients who traveled outside their geographic areas for their cancer care often went great distances. The median distance traveled by rural cancer patients who traveled to urban cancer care providers was 47.8 miles or more. A substantial proportion (between 19.4% and 26.0%) of all rural patients bypassed their closest medical and radiation oncology services by at least 30 miles.


CONCLUSIONS
Rural CRC patients often travel long distances for their CRC care, with potential associated burdens of time, cost, and discomfort. Better understanding of whether this travel investment is paid off in improved quality of care would help rural cancer patients, most of whom are elderly, make informed decisions about how to use their resources during their cancer treatment.
Baldwin
Laura-Mae
LM
Department of Family Medicine, University of Washington, Seattle, WA 98195, USA. lmb@fammed.washington.edu.
Cai
Yong
Y
Larson
Eric H
EH
Dobie
Sharon A
SA
Wright
George E
GE
Goodman
David C
DC
Matthews
Barbara
B
Hart
L Gary
LG
D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D002391:Catchment Area, Health; D015179:Colorectal Neoplasms / Q000145:classification / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008511:Medicine; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012424:Rural Population; D018426:SEER Program; D013038:Specialization; D014195:Travel; D014481:United States / Q000453:epidemiology; D014505:Urban Population