Surgeons investigate whether rural colon cancer patients fare worse than urban patients

October 3, 2012

Colon cancer patients living in rural areas are less likely to receive an early diagnosis, chemotherapy, or thorough surgical treatment when compared with patients living in urban areas. Rural residents are also more likely to die from their colon cancer than urban patients, according to new research findings from surgeons at the University of Minnesota, Minneapolis, and the Minneapolis Veterans Affairs Medical Center. The study was presented earlier today at the American College of Surgeons 2012 Annual Clinical Congress.

is the third-leading cause of for both men and women. The estimates that approximately 141,200 people were diagnosed with the disease in 2011. It's been previously determined that disparities in colon cancer outcomes already depend to some extent on race and insurance status, the researchers reported. These new study results show that patients' geographic locations can be added to the list.

"Often we will see patients from rural areas outside of Minneapolis. They've traveled hours to get to the university and they sometimes travel hours to get to their operations, radiation, and chemotherapy," explained Christopher J. Chow, MD, a categorical general surgery resident at the University of Minnesota. "We wanted to know if that factor was a barrier to receiving care. Early reports looking at this question tend to focus on . Research shows that rural patients don't get screened for cancer as often as urban patients do, and this difference affects their outcomes. But no one had really looked at the full spectrum of diagnosis and treatment. We wanted to look at what happens with rural patients at various stages of the process."

Dr. Chow and colleagues analyzed data for this on more than 123,000 patients from the California Cancer Registry, one of the nation's most demographically diverse registries. Between 1996 and 2008, these rural patients were diagnosed with colon cancer from stage 0—meaning one or more malignant polyps were removed—to stage IV whereby a large malignant tumor was detected and the cancer had spread to other organs.

About 15 percent of the patients in this study resided in rural areas, which were prede-fined by the registry. "Many registries simply classify patient rurality by the county they live in, but I could be sitting in suburbia on one side of a county and be considered as rural as someone else sitting on a farm on the opposite side of that same county," Dr. Chow explained. "Data sets that consider rurality by county alone may consider some people [as] living in urban areas even though they are rural."

The researchers looked at each patient's stage of diagnosis, whether cancerous lymph nodes were thoroughly removed, and whether stage-III patients received chemotherapy. They also compared the risk of death from colon cancer between the two groups.

After controlling for the influence of other factors including race, sex, age, marital status, , and year of diagnosis, their logistic regressions revealed that rural residents had 4 percent higher odds than urban patients of receiving a stage III or IV diagnosis. Rural patients with stages I–III colon cancer also had 18 percent lower odds of receiving an adequate lymphadenectomy, meaning a substandard number of lymph nodes were removed during the operation. Inadequate lymph node removal can be an indicator of the care team's quality. "It's a surrogate marker for how the different groups involved in the patients' care performed—the pathology technician, the pathologist, and the surgeon," he added.

The researchers also found that rural patients at stage III had 17 percent lower odds of receiving chemotherapy than urban patients, and they had a 5 percent higher hazard of cancer-specific death compared to those in the urban group, after adjusting for patient, tumor, and treatment factors.

"These findings do not mean that if you're a rural patient and you've been diagnosed with colon cancer [that] you should move," Dr. Chow cautioned. "What they mean is that, we as surgeons who treat both rural and urban patients, need to start targeting rural patients to ensure that they receive care that is as high quality as urban patients."

Dr. Chow added that the study's results indicate a need for deeper probing as to why patient rurality somehow impacts care quality measures. "Future studies have to look at the reasons why," he said. "Are rural patients not traveling and missing appointments, or are they missing appointments because they are traveling? We have to address the underlying reasons, since we know from the start that these tend to fare worse," he concluded.

Explore further: Study showed oxaliplatin improved colon cancer patient survival

Related Stories

Study showed oxaliplatin improved colon cancer patient survival

January 20, 2012
Stage III colon cancer patients in the general population who receive adjuvant treatment for the disease have an improved rate of survival when oxaliplatin is added to 5-fluorouracil (5FU), according to a study published ...

Rural women more likely to be diagnosed with most serious form of breast cancer

October 24, 2011
Women living in rural areas face unique challenges concerning health and wellness issues. Now, an MU researcher has found that rural women are more likely than women living in cities to be diagnosed with late-stage breast ...

Financial hardship common among colon cancer patients

March 13, 2012
(HealthDay) -- Nearly 40 percent of patients undergoing adjuvant chemotherapy for stage III colon cancer experience financial hardship, even if they have health insurance coverage, according to research published online March ...

Recommended for you

Researchers compose guidelines for handling CAR T cell side effects

September 19, 2017
Immune-cell based therapies opening a new frontier for cancer treatment carry unique, potentially lethal side effects that provide a new challenge for oncologists, one addressed by a team led by clinicians at The University ...

Altitude training for cancer-fighting cells

September 18, 2017
Mountain climbers and endurance athletes are not the only ones to benefit from altitude training - that is, learning to perform well under low-oxygen conditions. It turns out that cancer-fighting cells of the immune system ...

Metabolism can be used to subtype hepatoblastoma tumors

September 18, 2017
Looking at cell metabolism instead of histology, EPFL scientists have identified new biomarkers that could help more accurately classify the two main subtypes of hepatoblastoma, a children liver cancer.

A new paradigm for treating transcription factor-driven cancers

September 18, 2017
In the current issue of Proceedings of the National Academy of Sciences, researchers from Nationwide Children's Hospital describe a new paradigm for treating transcription factor-driven cancers. The study focuses on Ewing ...

Scientists find bacteria in pancreatic tumors that metabolize a common drug

September 15, 2017
To the reasons that chemotherapy sometimes does not work, we can now add one more: bacteria. In a study published today in Science, researchers describe findings that certain bacteria can be found inside human pancreatic ...

New technologies combined to identify specific DNA defect underlying a type of cancer

September 15, 2017
(Medical Xpress)—A team of researchers from the Netherlands and the U.K. has developed a technique for studying inherited types of cancers using two relatively new technologies—organoid development and CRISPR/Cas9. In ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.