title: Disparities in the Utilization of Laparoscopic Surgery for Colon Cancer in Rural Nebraska: A Call for Placement and Training of Rural General Surgeons.
abstract: BACKGROUND
  Advances in medical technology are changing surgical standards for colon cancer treatment. The laparoscopic colectomy is equivalent to the standard open colectomy while providing additional benefits. It is currently unknown what factors influence utilization of laparoscopic surgery in rural areas and if treatment disparities exist. The objectives of this study were to examine demographic and clinical characteristics associated with receiving laparoscopic colectomy and to examine the differences between rural and urban patients who received either procedure.
  
  
  METHODS
  This study utilized a linked data set of Nebraska Cancer Registry and hospital discharge data on colon cancer patients diagnosed and treated in the entire state of Nebraska from 2008 to 2011 (N = 1,062). Multiple logistic regression analysis was performed to identify predictors of receiving the laparoscopic treatment.
  
  
  RESULTS
  Rural colon cancer patients were 40% less likely to receive laparoscopic colectomy compared to urban patients. Independent predictors of receiving laparoscopic colectomy were younger age (<60), urban residence, ≥3 comorbidities, elective admission, smaller tumor size, and early stage at diagnosis. Additionally, rural patients varied demographically compared to urban patients.
  
  
  CONCLUSIONS
  Laparoscopic surgery is becoming the new standard of treatment for colon cancer and important disparities exist for rural cancer patients in accessing the specialized treatment. As cancer treatment becomes more specialized, the importance of training and placement of general surgeons in rural communities must be a priority for health care planning and professional training institutions.
authors.affiliation: Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska.
authors.forename: Kelli
authors.initials: K
authors.lastname: Gruber
authors.affiliation: Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska.
authors.forename: Amr S
authors.initials: AS
authors.lastname: Soliman
authors.affiliation: Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska.
authors.forename: Kendra
authors.initials: K
authors.lastname: Schmid
authors.affiliation: Nebraska Department of Health and Human Services, Lincoln, Nebraska.
authors.forename: Bryan
authors.initials: B
authors.lastname: Rettig
authors.affiliation: Nebraska Cancer Coalition, Omaha, Nebraska.|Nebraska Comprehensive Cancer Control Program, Nebraska Department of Health and Human Services, Lincoln, Nebraska.
authors.forename: June
authors.initials: J
authors.lastname: Ryan
authors.affiliation: Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Watanabe-Galloway
mesh_terms: D003082:Colectomy / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D009329:Nebraska / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data
keywords: access to care; colon cancer; laparoscopic colectomy; minimally invasive surgery; rural disparities