Hao Scarlett, Meyer David, Klose Charles, Irish William, Honaker Michael D
Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA.
East Carolina University Brody School of Medicine, Greenville, NC, USA.
Int J Colorectal Dis. 2023 Jan 11;38(1):8. doi: 10.1007/s00384-022-04300-w.
Studies have shown patients residing in rural settings have worse cancer-related outcomes than those in urban settings. Specifically, rural patients with colorectal cancer have lower rates of screening and longer time to treatment. However, physical distance traveled has not been as well studied. This study sought to determine disparities in receipt of surgery in patients by distance traveled for care.
A retrospective cohort study of patients with AJCC stage II/III rectal adenocarcinoma was identified within the National Cancer Database (2004-2017). Primary outcome was correlation of distance traveled to receipt of surgery. Multi-variable logistic regression was used to adjust for confounding factors.
65,234 patients were included in the analysis. 94.6% resided in urban-metro areas while 2.2% resided in rural areas. Patients were predominantly non-Hispanic White (NHW) (75.2%) with an overall median age at diagnosis of 61 (IQR 52-71). Overall, 82.6% of patients received surgery. NHW patients were more likely to receive surgery than non-Hispanic Black patients (OR 0.67; 95% CI 0.61-0.73, p < 0.001), as were patients who were privately insured (OR 1.90, 95% CI 1.67-2.15, p < 0.001) or had Medicare (OR 1.68, 95% CI 1.47-1.92, p < 0.001) compared to uninsured patients. Patients traveling distances in the 4th quartile (median 47.9 miles) were more likely to receive surgery than those traveling the shortest distances (1st quartile: median 2.5 miles) (OR 1.37, 95% CI 1.24-1.50, p < 0.001).
Patients traveling farther distances were more likely to receive surgery than those traveling shorter distances. Shorter distance traveled does not appear to be associated with higher rates of surgical resection in patients with stage II/III rectal cancer.
研究表明，居住在农村地区的癌症患者的相关预后比城市患者更差。具体而言，农村结直肠癌患者的筛查率较低，治疗时间较长。然而，患者就医所需的实际路程远近对治疗的影响尚未得到充分研究。本研究旨在确定患者因就医路程远近在接受手术治疗方面存在的差异。
在国家癌症数据库（2004 - 2017年）中对美国癌症联合委员会（AJCC）II/III期直肠腺癌患者进行回顾性队列研究。主要结局是就医路程与接受手术治疗之间的相关性。采用多变量逻辑回归分析来调整混杂因素。
共有65234例患者纳入分析。其中94.6%居住在城市大都市区，2.2%居住在农村地区。患者主要为非西班牙裔白人（NHW）（75.2%），总体诊断时的年龄中位数为61岁（四分位间距52 - 71岁）。总体而言，82.6%的患者接受了手术。与非西班牙裔黑人患者相比，NHW患者接受手术的可能性更大（比值比[OR] 0.67；95%置信区间[CI] 0.61 - 0.73，p < 0.001）；与未参保患者相比，参加私人保险的患者（OR 1.90，95% CI 1.67 - 2.15，p < 0.001）或参加医疗保险的患者（OR 1.68，95% CI 1.47 - 1.92，p < 0.001）接受手术的可能性更大。与路程最短（第一四分位数：中位数2.5英里）的患者相比，路程处于第四四分位数（中位数47.9英里）的患者接受手术的可能性更大（OR 1.37，95% CI 1.24 - 1.50，p < 0.001）。
与路程较短的患者相比，路程较远的患者接受手术的可能性更大。对于II/III期直肠癌患者，较短的就医路程似乎与更高的手术切除率无关。
