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


METHODS
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.


METHODS
The study was conducted using the 1996-2008 California Cancer Registry.


METHODS
All of the patients diagnosed between 1996 and 2008 with tumors located in the colon were eligible for inclusion in this study.


METHODS
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.


CONCLUSIONS
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).
1 Department of Surgery, University of Minnesota, Minneapolis, Minnesota 2 Department of Surgery, Georgetown University Hospital and Lombardi Comprehensive Cancer, Washington, District of Columbia 3 Genentech, South San Francisco, California 4 Division of Health Care Policy and Research and Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
Christopher J
CJ
Chow
Waddah B
WB
Al-Refaie
Anasooya
A
Abraham
Abraham
A
Markin
Wei
W
Zhong
David A
DA
Rothenberger
Mary R
MR
Kwaan
Elizabeth B
EB
Habermann
D000328:Adult; D000368:Aged; D002140:California; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D015996:Survival Rate