title: Regional disparities affect treatment and survival of patients with intrahepatic cholangiocarcinoma--a Texas Cancer Registry analysis.
abstract: BACKGROUND
  Intrahepatic cholangiocarcinoma (ICC) is often diagnosed at advanced stage and few patients qualify for resection. Effects of barriers to access on outcomes are unknown. We hypothesized that income and rural residence account for delays in treatment and decreased survival.
  
  
  METHODS
  Texas Cancer Registry was queried for ICC patients from 2000 to 2008. Median household income (MHI) and urban/rural status were analyzed. Regression analyses were performed for (1) time-to- treatment (TTT), and (2) overall survival (OS).
  
  
  RESULTS
  Among 1,089 patients, 20.2% patients resided in rural areas and MHI ranged $24,497-$81,113/year. Primary treatment included surgery for 9.5%, radiation 5.4% and chemotherapy 21.0%. Median TTT was 29 (range 0-235) days. Patients from low-income areas were less likely to receive treatment (below median MHI, 29.7% vs. above median MHI, 37.5%%; P = 0.007). MHI was associated with TTT (per $10,000/year: hazard ratio (HR) = 1.05; 95% CI: 1.01-1.09). Adjusting for stage, MHI was associated with OS (per $10,000/year: HR = 0.97; 95%CI: 0.94-0.99). Rural residence was neither associated with TTT nor OS.
  
  
  CONCLUSIONS
  Overall treatment rates for ICC patients are low. Regional income, not urbanization was associated treatment and survival independent of stage. Further research is needed to determine how regional prosperity relates to care access.
authors.affiliation: Department of Surgery, University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kneuertz
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.forename: Tien C
authors.initials: TC
authors.lastname: Ko
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Wray
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D018281:Cholangiocarcinoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012044:Regression Analysis; D013781:Texas
keywords: access; disparities; income; intrahepatic cholangiocarcinoma; rural; survival; treatment