Nguyen Minh-Tri, Wei Wei, Cooper Gregory, Khorana Alok A, Kamath Suneel
Oncology (Williston Park). 2023 Jan 26;37(1):19-24. doi: 10.46883/2023.25920982.
Cancer care in rural areas poses unique challenges, including access and proximity to care. This study examined differences in time to treatment initiation (TTI), a potential surrogate for access, and predictors of overall survival (OS) between rural and nonrural patients with breast cancer.
Women with stage I to III breast cancer diagnosed between 2004 and 2012 in facilities accredited by the National Cancer Database of Commission on Cancer (CoC) were included. Differences between rural and nonrural patients in demographics, disease and treatment characteristics, socioeconomic factors, and TTI were assessed by χ2 test. The effects on OS of age, insurance status, cancer center type, community median income, percentage of the community who had not graduated from high school, and TTI were assessed using Cox models.
The study population was composed of 1,205,031 patients, 18,417 (2%) of whom were rural. Compared with nonrural patients, rural patients were more likely to be older, to be White, to receive care at nonacademic centers, to have government insurance or annual income less than $38,000, and to be less educated (P < .0001). Rural patients also had shorter median TTI (3 vs 4 weeks; P < .0001), which was associated with improved OS (P < .0001), and were more likely to have TTI less than 4 weeks and less than 8 weeks (P < .0001 for both). Shorter TTI (both <4 weeks vs 8 weeks and 4-8 weeks vs >8 weeks) was also associated with improved OS (P < .0001 for both). After adjusting for disease stage and demographic-, socioeconomic-, and treatment-related factors, rural status was associated with improved OS compared with nonrural status (HR, 0.92; 95% CI, 0.89-0.96; P < .0001).
Despite several adverse demographic and socioeconomic factors, rural patients with breast cancer with access to CoC-accredited facilities had significantly shorter TTI and better OS compared with nonrural patients. The clinical significance of this is undetermined; however, these data suggest that improving TTI can mitigate disparities in rural cancer care.
农村地区的癌症护理面临着独特的挑战，包括获得医疗服务的机会以及与医疗机构的距离。本研究调查了农村和非农村乳腺癌患者在治疗开始时间（TTI，可作为获得医疗服务机会的一个潜在替代指标）方面的差异，以及总生存期（OS）的预测因素。
纳入2004年至2012年期间在癌症委员会国家癌症数据库（CoC）认可的机构中诊断为I至III期乳腺癌的女性患者。通过χ²检验评估农村和非农村患者在人口统计学、疾病和治疗特征、社会经济因素以及TTI方面的差异。使用Cox模型评估年龄、保险状况、癌症中心类型、社区中位收入、未高中毕业的社区人口百分比以及TTI对OS的影响。
研究人群包括1,205,031名患者，其中18,417名（2%）为农村患者。与非农村患者相比，农村患者更可能年龄较大、为白人、在非学术中心接受治疗、拥有政府保险或年收入低于38,000美元，且受教育程度较低（P <.0001）。农村患者的中位TTI也较短（3周对4周；P <.0001），这与OS改善相关（P <.0001），并且更可能TTI小于4周和小于8周（两者P <.0001）。较短的TTI（<4周对8周以及4 - 8周对>8周）也与OS改善相关（两者P <.0001）。在调整疾病分期以及人口统计学、社会经济和治疗相关因素后，与非农村状态相比，农村状态与OS改善相关（HR，0.92；95% CI，0.89 - 0.96；P <.0001）。
尽管存在一些不利的人口统计学和社会经济因素，但与非农村患者相比，能够获得CoC认可机构服务的农村乳腺癌患者的TTI明显更短，OS更好。其临床意义尚不确定；然而，这些数据表明改善TTI可以减轻农村癌症护理中的差异。
