Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3443, Durham, NC, 27710, USA.
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Gastrointest Surg. 2019 Nov;23(11):2285-2293. doi: 10.1007/s11605-019-04270-5. Epub 2019 May 31.
Rural patients experience disparities in cancer care compared to urban patients. We hypothesized that rural patients with colon cancer who traveled to high-volume centers for treatment have similar survival compared to urban patients who also traveled to high-volume centers to seek treatment for colon cancer.
The National Cancer Database was interrogated for patients treated for stage I-III colon cancer (2004-2015). Travel distance to treatment centers and annual hospital volume were divided into quartiles. Two groups of patients were identified and compared: (1) rural patients who traveled to high-volume hospitals and (2) urban patients who also traveled to high-volume centers. The primary outcome was overall survival (OS).
Of 647,949 patients, 634, 447 were urban and 13,502 were rural. Rural patients were more likely to be Caucasian, with lower income, more comorbidities, and be treated at non-academic centers. In multivariable analysis, rural patients had worse OS compared to urban patients (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.04-1.12; p = < 0.001). There were 46,781 (7%) urban patients and 1276 (9%) rural patients who traveled a long distance (median 40 and 108 miles, respectively) to high-volume centers. There was no difference in adjusted OS between urban and rural patients who traveled to high-volume centers for treatment (HR 1.06; 95%CI 0.94-1.20; p = 0.36).
This nationwide analysis suggests that rural patients with colon cancer experience worse survival than urban patients, but that this disparity might be mitigated by rural patients traveling to high-volume centers for treatment.
与城市患者相比，农村癌症患者在癌症治疗方面存在差异。我们假设，前往高容量中心接受治疗的农村结肠癌患者的生存情况与前往高容量中心接受治疗的城市结肠癌患者相似。
国家癌症数据库对 2004 年至 2015 年接受 I-III 期结肠癌治疗的患者进行了调查。治疗中心的旅行距离和医院的年容量被分为四分位。确定并比较了两组患者：（1）前往大容量医院的农村患者；（2）也前往大容量中心的城市患者。主要结局是总生存率（OS）。
在 647949 名患者中，634447 名是城市患者，13502 名是农村患者。农村患者更有可能是白人，收入较低，合并症更多，并且在非学术中心接受治疗。多变量分析显示，农村患者的 OS 比城市患者差（风险比 [HR] 1.08；95%置信区间 [CI] 1.04-1.12；p<0.001）。有 46781 名（7%）城市患者和 1276 名（9%）农村患者长途（中位数分别为 40 英里和 108 英里）前往大容量中心。前往大容量中心接受治疗的城市和农村患者的调整后 OS 无差异（HR 1.06；95%CI 0.94-1.20；p=0.36）。
这项全国性分析表明，农村结肠癌患者的生存情况比城市患者差，但农村患者前往大容量中心接受治疗可能会减轻这种差距。
