Rural-Urban Disparities in Cancer Care-Analyzing Routinely Collected Patient-Reported Outcomes. A Cross-Sectional Study.

OBJECTIVE

Rural-urban disparities in cancer care are well documented. However, research on rural-urban disparities regarding patient-reported outcomes (PROs) is still developing. This study analyzed rural-urban disparities in patients with cancer with respect to anxiety, depression, fatigue, pain interference, and physical function.

METHODS

This study was conducted at the University of Utah Huntsman Cancer Institute. We integrated data from electronic health records, Cancer Registry, and PRO questionnaires. We assessed the association between rurality status (rural vs. urban) in patients with cancer and PRO scores using multiple linear regression models and t-tests.

RESULTS

The cohort included 7271 patients. The mean age was 59.1 years at cancer diagnosis and 48.2% (n = 3505) were female. Across all cancer types, significant differences (Rural vs. Urban) were found for fatigue (53.6 vs. 54.1; p < 0.05) and physical function (45.5 vs. 45.1; p < 0.05). With respect to specific cancer types, there were differences in patients with oral cavity and pharynx cancer for depression (47.9 vs. 50.6; p < 0.01), fatigue (51.6 vs. 54.8; p < 0.05), pain interference (52.8 vs. 55.4; p < 0.05), and physical function (48.0 vs. 44.6; p < 0.01), colorectal cancer for fatigue (56.8 vs. 54.7; p < 0.05), pain interference (56.0 vs. 53.7; p < 0.05), and physical function (42.2 vs. 44.4; p < 0.05), uterus cancer for depression (47.5 vs. 50.5; p < 0.05) and fatigue (51.6 vs. 54.7; p < 0.05), and lung cancer for physical function (37.6 vs. 39.3; p < 0.05).

CONCLUSIONS

Across all cancer types, as well as specific cancers, this study found mostly limited rural-urban differences regarding PROs. Except for colorectal and lung/bronchus cancer, patients living in rural areas reported similar or better PRO scores for all cancer types. Results support the hypothesis that improving access can help to level rural-urban disparities regarding cancer care outcomes, because all patients were treated in the same comprehensive cancer center, had similar access to care, and had similar PRO scores.