Wang Chen Chia, Farmer Trevor, Garland-Kledzik Mary, Magge Deepa R
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Surgery, West Virginia University School of Medicine, Morgantown, WV, USA.
Am Surg. 2025 Apr;91(4):633-638. doi: 10.1177/00031348241312124. Epub 2025 Jan 3.
The Appalachian region consists of over 26 million Americans, of whom almost 2.5 million live in rural areas. Various social determinants of health including but not limited to rural living conditions and geographic isolation, food insecurity, and low income contribute to disparate health outcomes compared to the rest of the country. Obesity, hypertension, diabetes, stroke, and chronic heart diseases are all more prevalent in Appalachia. These comorbidities, combined with the aforementioned social vulnerabilities, place the Appalachian population at increased risk of higher cancer incidence and poorer outcomes. Lung, cervical, breast, penile, prostate, colorectal, and head and neck cancers are all shown to have higher rates and poorer outcomes within Appalachia relative to the country. Advanced staged colorectal cancer patients are a unique population that may be even further impacted by the social inequities in Appalachia, given the resource-intensive and multi-disciplinary approach required for effective treatment. Unfortunately, there is a dire lack of investigation into the incidence and outcomes of advanced stage colorectal cancer in Appalachian residents. This review summarizes the existing literature on disparate cancer outcomes in the Appalachian population, with a focus on advanced stage colorectal cancer. We also propose various approaches that could decrease malignancy rates and improve outcomes, such as dietary adjustments, screening tools, and public educational endeavors. We also acknowledge the role high-volume centers can play in working towards accessible care and the potential for collaborations between large institutions within Appalachian regions to spur the change that is greatly needed.
阿巴拉契亚地区有超过2600万美国人，其中近250万人生活在农村地区。与美国其他地区相比，包括但不限于农村生活条件和地理隔离、粮食不安全以及低收入在内的各种健康社会决定因素导致了不同的健康结果。肥胖、高血压、糖尿病、中风和慢性心脏病在阿巴拉契亚地区都更为普遍。这些合并症，再加上上述社会脆弱性，使阿巴拉契亚人口患癌症的发病率更高、预后更差的风险增加。相对于全国而言，肺癌、宫颈癌、乳腺癌、阴茎癌、前列腺癌、结直肠癌以及头颈癌在阿巴拉契亚地区的发病率都更高，预后也更差。晚期结直肠癌患者是一个独特的群体，鉴于有效治疗需要资源密集型和多学科方法，他们可能会受到阿巴拉契亚地区社会不平等的更大影响。不幸的是，对于阿巴拉契亚居民晚期结直肠癌的发病率和预后，严重缺乏相关研究。本综述总结了关于阿巴拉契亚人群不同癌症预后的现有文献，重点关注晚期结直肠癌。我们还提出了各种可以降低恶性肿瘤发生率并改善预后的方法，例如饮食调整、筛查工具和公共教育努力。我们也认识到高容量中心在实现可及医疗方面可以发挥的作用，以及阿巴拉契亚地区大型机构之间合作推动急需变革的潜力。
