Lane Sarah, Smith Bailey, Brodersen Carly, Hanson Schae, Spanos William, Powell Steven
University of South Dakota Sanford School of Medicine.
S D Med. 2025 May;78(suppl 5):s31.
Patients with head and neck squamous cell carcinoma (HNSCC) receiving chemoradiotherapy require ongoing treatment and follow-up, which may be influenced by distance to care. Rural patients often face limited access to specialized treatment centers, yet data on rurality's impact on compliance and outcomes remain limited. This study evaluates differences in treatment adherence and outcomes between rural and urban HNSCC patients.
Retrospective chart review identified patients with HNSCC treated with chemoradiotherapy from 2010-2019 at Sanford Health in Sioux Falls, South Dakota; Fargo, North Dakota; and Bismark, North Dakota. Patients were classified as either rural (R) or urban (U) based on their home address using the Federal Office of Rural Health Policy (FORHP) definition. Differences in patient and disease characteristics were analyzed. Post-treatment complications (ototoxicity, osteoradionecrosis, and treatment compliance (major delays in radiation treatment [greater than 5 days] and prolonged time to complete radiation [greater than 52 days]) were compared between groups using chi-squared and t-tests.
132 patients met eligibility. Participants were predominantly male (80% U, 83.1% R), Medicare/ Medicaid (66.2% R, 60% U), Oropharynx (57.1% R, 61.8% U), and stage IV (84.4% R, 85.5% U). There was no significant difference in number of missed appointments (p=0.16), treatment breaks (p=0.15), prolonged time to complete radiation (p=0.67). Post-treatment complication rates were also similar: ototoxicity (R: 51.9%, U: 58.2%, p=0.49), osteoradionecrosis (R: 16.9%, U: 7.3%, p=0.1), and soft tissue necrosis (R: 35.1%, U: 27.3%, p=0.34).
Rural and urban HNSCC patients showed no significant differences in treatment adherence or outcomes. These findings suggest that rural patients may have access to sufficient resources and support, enabling them to receive cancer treatment comparable to their urban counterparts. However, this study may be limited by its relatively small sample size, and further research is warranted to explore this topic in larger and more diverse populations.
接受放化疗的头颈部鳞状细胞癌（HNSCC）患者需要持续的治疗和随访，而这可能会受到就医距离的影响。农村患者往往难以获得专门的治疗中心，然而关于农村地区对依从性和治疗结果影响的数据仍然有限。本研究评估农村和城市HNSCC患者在治疗依从性和治疗结果方面的差异。
通过回顾性病历审查，确定了2010年至2019年在南达科他州苏福尔斯、北达科他州法戈和北达科他州俾斯麦的桑福德健康中心接受放化疗的HNSCC患者。根据患者的家庭住址，使用联邦农村卫生政策办公室（FORHP）的定义将患者分为农村（R）或城市（U）。分析患者和疾病特征的差异。使用卡方检验和t检验比较两组之间的治疗后并发症（耳毒性、放射性骨坏死）和治疗依从性（放疗主要延迟[大于5天]和完成放疗时间延长[大于52天]）。
132名患者符合入选标准。参与者主要为男性（城市组80%，农村组83.1%），医疗保险/医疗补助参保者（农村组66.2%，城市组60%），口咽癌患者（农村组57.1%，城市组61.8%），IV期患者（农村组84.4%，城市组85.5%）。错过预约的次数（p = 0.16）、治疗中断（p = 0.15）、完成放疗时间延长（p = 0.67）方面无显著差异。治疗后并发症发生率也相似：耳毒性（农村组：51.9%，城市组：58.2%，p = 0.49），放射性骨坏死（农村组：16.9%，城市组：7.3%，p = 0.1），软组织坏死（农村组：35.1%，城市组：27.3%，p = 0.34）。
农村和城市HNSCC患者在治疗依从性或治疗结果方面无显著差异。这些发现表明农村患者可能有足够的资源和支持，使他们能够接受与城市患者相当的癌症治疗。然而，本研究可能受样本量相对较小的限制，有必要进行进一步研究以在更大和更多样化的人群中探讨这一主题。
