Similar care, similar outcomes for rural and urban cancer patients

 
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Rural-urban disparities in cancer outcomes recede for patients enrolled in clinical trials, a new study in JAMA Network Open finds.

The study’s authors explain that patients who participate in clinical trials “are uniformly staged, treated, and followed up under protocol-specific guidelines, reducing the potential influences of inconsistent pretreatment evaluation, care, and posttreatment surveillance.”

Statistics from the U.S. Centers for Disease Control and Prevention indicate that rural areas have higher cancer death rates than urban areas. Between 2011 and 2015, the age-adjusted rate for cancer deaths in rural areas was 180 per 100,000 people, compared with 158 per 100,000 in urban areas.

“While these disparities are reported, sometimes it can be very difficult to distinguish what comes from treatment, and what comes from access, and what comes from biology,” Dawn Hershman, an oncologist at Columbia University Medical Center and one of the paper’s authors, said in a phone interview with Journalist’s Resource.

But when patients received uniform care, uniform results followed – regardless of where they lived.

Hershman and her colleagues, who are researchers at the Fred Hutchinson Cancer Research Center, Sweetwater Regional Cancer Center and University of Texas MD Anderson Cancer Center, looked at survival outcomes for 37,000 cancer patients across the country enrolled in clinical trials between 1986 and 2012.

The researchers used Rural-Urban Continuum Codes developed by the U.S. Department of Agriculture to categorize enrollees by residence.

The study involved patients enrolled in clinical trials for 17 different types of cancers. For 16 of these cancers, there were no significant differences in five-year survival outcomes between rural and urban patients.

The only type of cancer for which rural patients had worse outcomes as compared with their urban peers was adjuvant-stage, estrogen receptor-negative and progesterone receptor-negative breast cancer.

Hershman noted one limitation of the study — patients who enroll in clinical trials have a tendency to be healthier and more compliant. “To a certain extent, it does self-select people who may be more on top of their care,” she said.

Nevertheless, she suggested the findings point to a few practicable health care interventions: “There are a lot of things we can’t solve that lead to disparities, but if this is one component, this is something we can solve.”

“It helps from a policy standpoint to say, well, we need to do more to improve access for patients that live in rural communities,” Hershman said.

Another takeaway: “We need to make sure everyone is receiving high-quality care like they would in clinical trials,” she added.

“This issue of access for patients that live in rural areas has not received a lot of attention, but it’s an area that really we need to think a lot about, because our treatments are getting better, but also both more costly and more complicated,” Hershman concluded. “We need to think about innovative ways of getting patients care in the communities that they live in.”

 

Reporting on rural areas? Journalist’s Resource has put together a tip sheet highlighting common mistakes; we’ve also covered research on rural mothers and educational disparities.

Last updated: August 22, 2018

 

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Citation: Unger, Joseph M.; et al. "Geographic Distribution and Survival Outcomes for Rural Patients with Cancer Treated in Clinical Trials," JAMA Network Open, 2018. DOI: 10.1001/jamanetworkopen.2018.1235.