65: Q&A

The NCDB was queried for records with stage 1-3 colon and rectal cancer. Guideline-concordant therapy (GCT) was defined as documentation of surgery alone for localized colon (stage 1-2) and rectal (stage 1) cancers, surgery with adjuvant chemotherapy for stage 3 colon cancer, or surgery, chemotherapy, and radiation therapy for stage 2-3 rectal cancer.  Need for multimodal therapy (MMT) was defined by having stage 3 colon or stage 2-3 rectal cancer.


Results:

There were 325,756 records included for analysis. Compared to urban patients, rural patients had a higher proportion of white race (91.2% vs 86.2%, p< 0.01), traveled further for treatment (median 46.7 vs 8.2 miles, p< 0.01), were more likely to live in a lowest income area (39.0 vs 16.1%, p< 0.01), but had similar rates of need of MMT (48.4% vs 45.9%). Failure to receive GCT was higher for non-white patients (75.1% vs 77.9%, p< 0.01), non-private insurance (74.3% vs 83.3%, p< 0.01), rectal vs colon cancers (36.9% vs 64.8% p< 0.01), and patients who required MMT (61.5% vs 91.0%, p< 0.01). The rate of GCT was overall similar between urban and rural patients (79.4% vs 77.3%, p< 0.01), but did fluctuate with differences in travel distance (Figure). In the adjusted multivariate model, we found that patients from rural county were more likely to receive GCT compared to urban (OR 1.33, 95% CI 1.23-1.43, p< 0.01). However, when overall survival was compared between urban and rural patients, survival was better for urban patients compared to rural patients (median 111.1 vs 93.7 months, p< 0.01).


Conclusions: Receipt of GCT does not appear to differ drastically between urban and rural patients, but rural patients have decreased survival for non-metastatic colorectal cancer compared to urban-dwelling patients.  Additional unmeasured social determinants of health likely contribute to the disparate survival outcomes between these two populations.