Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2019 May;28(5):882-889. doi: 10.1158/1055-9965.EPI-18-0945. Epub 2019 Feb 7.
Although rural cancer patients encounter substantial barriers to care, they more often report receiving timely care than urban patients. We examined whether geographic distance, a contributor to urban-rural health disparities, differentially influences treatment initiation and completion among insured urban and rural cervical cancer patients.
We identified women diagnosed with cervical cancer from 2004 to 2013 from a statewide cancer registry linked to multipayer, insurance claims. Primary outcomes were initiation of guideline-concordant care within 6 weeks of diagnosis and, among stage IB2-IVA cancer patients, completion of concurrent chemoradiotherapy (CCRT) in 56 days. We estimated risk ratios using modified Poisson regressions, stratified by urban/rural status, to examine the association between distance and treatment timing (initiation or completion).
Among 999 stage IA-IVA patients, 48% initiated guideline-concordant care within 6 weeks of diagnosis, and 37% of 492 stage IB2-IVA cancer patients completed CCRT in 56 days. In urban areas, stage IA-IVA patients who lived ≥15 miles from the nearest treatment facility were less likely to initiate timely treatment compared with those <5 miles [risk ratio (RR): 0.72; 95% confidence intervals (CI), 0.54-0.95]. Among IB2-IVA stage cancer patients, rural women residing ≥15 miles from the nearest radiation facility were more likely to complete CCRT in 56 days (RR: 2.49; 95% CI, 1.12-5.51).
Geographic distance differentially influences the initiation and completion of treatment among urban and rural cervical cancer patients.
Distance was an access barrier for insured cervical cancer patients in urban areas whereas rural patients may require more intensive outreach, support, and resources, even among those living closer to treatment.
尽管农村癌症患者在获得医疗方面面临着诸多障碍，但他们接受及时治疗的比例却高于城市患者。我们研究了地理距离（导致城乡健康差异的因素之一）是否会对参保的城乡宫颈癌患者的治疗开始和完成产生不同影响。
我们从一个与多支付方保险索赔相关联的全州癌症登记处，确定了 2004 年至 2013 年期间被诊断患有宫颈癌的女性。主要结局指标是在诊断后 6 周内开始符合指南的治疗，以及在 IB2-IVA 期癌症患者中，在 56 天内完成同期放化疗（CCRT）。我们使用修正泊松回归，按城乡状况分层，估计风险比，以检查距离与治疗时间（开始或完成）之间的关联。
在 999 名 IA-IVA 期患者中，48%在诊断后 6 周内开始进行符合指南的治疗，492 名 IB2-IVA 期癌症患者中有 37%在 56 天内完成 CCRT。在城市地区，与距离最近的治疗设施<5 英里的患者相比，距离治疗设施≥15 英里的 IA-IVA 期患者不太可能及时开始治疗[风险比（RR）：0.72；95%置信区间（CI），0.54-0.95]。对于 IB2-IVA 期癌症患者，距离最近的放射治疗设施≥15 英里的农村女性更有可能在 56 天内完成 CCRT（RR：2.49；95%CI，1.12-5.51）。
地理距离对城市和农村宫颈癌患者的治疗开始和完成产生了不同的影响。
距离是城市参保宫颈癌患者的一个获得医疗的障碍，而农村患者可能需要更密集的外联、支持和资源，即使是那些距离治疗更近的患者也是如此。
