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Association of distance traveled on receipt of surgery in patients with locally advanced rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Studies have shown patients residing in rural settings have worse cancer-related outcomes than those in urban settings. Specifically, rural patients with colorectal cancer have lower rates of screening and longer time to treatment. However, physical distance traveled has not been as well studied. This study sought to determine disparities in receipt of surgery in patients by distance traveled for care.

Methods

A retrospective cohort study of patients with AJCC stage II/III rectal adenocarcinoma was identified within the National Cancer Database (2004–2017). Primary outcome was correlation of distance traveled to receipt of surgery. Multi-variable logistic regression was used to adjust for confounding factors.

Results

65,234 patients were included in the analysis. 94.6% resided in urban-metro areas while 2.2% resided in rural areas. Patients were predominantly non-Hispanic White (NHW) (75.2%) with an overall median age at diagnosis of 61 (IQR 52–71). Overall, 82.6% of patients received surgery. NHW patients were more likely to receive surgery than non-Hispanic Black patients (OR 0.67; 95% CI 0.61–0.73, p < 0.001), as were patients who were privately insured (OR 1.90, 95% CI 1.67–2.15, p < 0.001) or had Medicare (OR 1.68, 95% CI 1.47–1.92, p < 0.001) compared to uninsured patients. Patients traveling distances in the 4th quartile (median 47.9 miles) were more likely to receive surgery than those traveling the shortest distances (1st quartile: median 2.5 miles) (OR 1.37, 95% CI 1.24–1.50, p < 0.001).

Conclusion

Patients traveling farther distances were more likely to receive surgery than those traveling shorter distances. Shorter distance traveled does not appear to be associated with higher rates of surgical resection in patients with stage II/III rectal cancer.

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Data availability

The primary dataset (National Cancer Database) is available publicly through the American College of Surgeons (https://www.facs.org/quality-programs/cancer/ncdb). The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. American Cancer Society (2021) Cancer facts & figures 2021. American Cancer Society, Atlanta

    Google Scholar 

  2. Sun W, Al-Rajabi R, Perez RO et al (2020) Controversies in rectal cancer treatment and management. Am Soc Clin Oncol Educ Book 40:136–146. https://doi.org/10.1200/EDBK_279871

    Article  Google Scholar 

  3. Turner MC, Keenan JE, Rushing CN et al (2019) Adjuvant chemotherapy improves survival following resection of locally advanced rectal cancer with pathologic complete response. J Gastrointest Surg 23(8):1614–1622. https://doi.org/10.1007/s11605-018-04079-8

    Article  PubMed  Google Scholar 

  4. Jones HJS, Cunningham C, Nicholson GA, Hompes R (2018) (2017) Outcomes following completion and salvage surgery for early rectal cancer: a systematic review. Eur J Surg Oncol 44(1):15–23. https://doi.org/10.1016/j.ejso.2017.10.212

    Article  PubMed  Google Scholar 

  5. Jagad RB, Koshariya M, Kawamoto J et al (2008) Management of rectal cancer: strategies and controversies. Hepatogastroenterology 55(81):82–92

    PubMed  Google Scholar 

  6. Franklyn J, Abdalkoddus M, Rossi B et al (2020) Prognosis of non-operative management of non-metastatic colorectal cancer in octa- and nonagenarians. Ann R Coll Surg Engl 102:504–509. https://doi.org/10.1308/rcsann.2020.0067

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Levit LA, Byatt L, Lyss AP et al (2020) Closing the rural cancer care gap: three institutional approaches. JCO Oncol Pract 16:422–430. https://doi.org/10.1200/OP.20.00174

    Article  PubMed  Google Scholar 

  8. Helewa RM, Turner D, Wirtzfeld D et al (2013) Geographical disparities of rectal cancer local recurrence and outcomes. Dis Colon Rectum 56(7):850–858. https://doi.org/10.1097/DCR.0b013e31828e15cb

    Article  PubMed  Google Scholar 

  9. Chioreso C, Gao X, Gribovskaja-Rupp I et al (2021) Hospital and surgeon selection for medicare beneficiaries with stage II/III rectal cancer. Ann Surg 274(4):336–344. https://doi.org/10.1097/0000000000003673

    Article  Google Scholar 

  10. Rectal Cancer (2022) National Comprehensive Cancer Network. Updated Feb 2022. Accessed 8 Aug 2022. https://www.nccn.org/professionals/physicians_gIs/pdf/rectal.pdf

  11. Boffa DJ, Rosen JE, Mallin K et al (2017) Using the National Cancer Database for outcomes research: a review. JAMA Oncol 3:1722–1728. https://doi.org/10.1001/jamaonccol.2016.6905

    Article  PubMed  Google Scholar 

  12. Mallin K, Browner A, Palis B et al (2019) Incident cases captured in the National Cancer Database compared with those in U.S. population based central cancer registries in 2012–2014. Ann Surg Oncol 26:1604–1612. https://doi.org/10.1245/s10434-019-07213-1

  13. Von Elm E, Altman DG, Egger M, Initiative STROBE et al (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008

    Article  Google Scholar 

  14. 2010 Census Redistricting Data (Public Law 94–171) (2021) Summary File— (name of state) [machine-readable data files]/prepared by the U.S. Census Bureau

  15. Rural-Urban Continuum Codes. United States Department of Agriculture and Economic Research Service. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes. Accessed 25 Aug 2022

  16. American College of Surgeons. National Cancer Database. https://facs.org/quality-programs/cancer/ncdb. Accessed 25 Aug 2022

  17. Loree JM, Javaheri KR, Lefresne SV et al (2017) Impact of travel distance and urban-rural status on the multidisciplinary management of rectal cancer. J Rural Health 33(4):393–401. https://doi.org/10.1111/jrh.12219

    Article  PubMed  Google Scholar 

  18. Nostedt MC, McKay AM, Hochman DJ et al (2014) The location of surgical care for rural patients with rectal cancer: patterns of treatment and patient perspectives. Can J Surg 57:398–404. https://doi.org/10.1503/cjs.002514

    Article  PubMed  PubMed Central  Google Scholar 

  19. Brand NR, Greenberg AL, Chiou SH, Adam M, Sarin A (2022) Association of distance, region, and insurance with advanced colon cancer at initial diagnosis. JAMA Netw Open 5(9):e2229954. Published 2022 Sep 1. https://doi.org/10.1001/jamanetworkopen.2022.29954

  20. Alvarez MA, Anderson K, Deneve JL et al (2021) Traveling for pancreatic cancer care is worth the trip. Am Surg 87(4):549–556. https://doi.org/10.1177/0003134820951484

    Article  PubMed  Google Scholar 

  21. Ely S, Jiang SF, Patel AR, Ashiku SK, Velotta JB (2020) Regionalization of lung cancer surgery improves outcomes in an integrated health care system. Ann Thorac Surg 110(1):276–283. https://doi.org/10.1016/j.athoracsur.2020.02.019

    Article  PubMed  Google Scholar 

  22. Pekala KR, Yabes JG, Bandari J et al (2022) The centralization of bladder cancer care and its implications for patient travel distance [published correction appears in Urol Oncol 40(5):203–206]. Urol Oncol 39(12):834.e9–834.e20. https://doi.org/10.1016/j.urolonc.2021.04.030

  23. Aquina CT, Probst CP, Becerra AZ et al (2016) High volume improves outcomes: the argument for centralization of rectal cancer surgery. Surgery 159(3):736–748. https://doi.org/10.1016/j.surg.2015.09.021

    Article  PubMed  Google Scholar 

  24. Aggarwal A, Han L, van der Geest S et al (2022) Health service planning to assess the expected impact of centralising specialist cancer services on travel times, equity, and outcomes: a national population-based modelling study. Lancet Oncol 23(9):1211–1220. https://doi.org/10.1016/S1470-2045(22)00398-9

    Article  PubMed  Google Scholar 

  25. Mujumdar V, Butler TR, Shalowitz DI (2021) A qualitative study on the impact of long-distance travel for gynecologic cancer care. Gynecol Oncol Rep 38:100868. Published 2021 Sep 25. https://doi.org/10.1016/j.gore.2021.100868

  26. de Jager E, Levine AA, Udyavar NR et al (2019) Disparities in surgical access: a systematic literature review, conceptual model, and evidence map. J Am Coll Surg 228:276–298. https://doi.org/10.1016/j.amcollsurg.2018.12.028

    Article  PubMed  PubMed Central  Google Scholar 

  27. Caldwell JT, Ford CL, Wallace SP et al (2016) Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States. Am J Public Health 106:1463–1469. https://doi.org/10.2105/AJPH.2016.303212

    Article  PubMed  PubMed Central  Google Scholar 

  28. Moss JL, Pinto CN, Srinivasan S et al (2022) Enduring cancer disparities by persistent poverty, rurality, and race: 1990–1992 to 2014–2018. J Natl Cancer Inst 114:829–836. https://doi.org/10.1093/jnci/djac038

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zahnd WE, Murphy C, Knoll M et al (2021) The intersection of rural residence and minority race/ethnicity in cancer disparities in the United States. Int J Environ Res Public Health 18:1384. https://doi.org/10.3390/ijerph18041384

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hall GM, Shanmugan S, Bleier JI et al (2016) Colorectal specialization and survival in colorectal cancer. Colorectal Dis 18(2):O51-60. https://doi.org/10.1111/codi.13246

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to acknowledge Reba Bullard for her assistance in manuscript preparation.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA

    Scarlett Hao, William Irish & Michael D. Honaker

  2. East Carolina University Brody School of Medicine, Greenville, NC, USA

    David Meyer & Charles Klose

  3. Division of Surgical Reseach, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA

    William Irish

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  1. Scarlett Hao
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Contributions

Scarlett Hao confirms confirmation of study conceptualization, methodology, data collection and analysis, writing, reviewing, and editing. David Meyer confirms confirmation of writing, reviewing, and editing. Charles Klose confirms confirmation of writing, reviewing, and editing. William Irish confirms confirmation of conceptualization, methodology, writing, reviewing, and editing. Michael Honaker confirms confirmation of conceptualization, methodology, data collection and writing, reviewing, and editing.

Corresponding author

Correspondence to Michael D. Honaker.

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Disclaimer

Established in 1989, The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The NCDB and its participating hospitals are the source of the data used herein. The data are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The American College of Surgeons has executed a Business Associate Agreement that includes a data use agreement with each of its CoC accredited hospitals. The National Cancer Database (NCDB) is a nationwide, facility-based, comprehensive clinical surveillance resource oncology data set that captures 72% of all newly diagnosed malignancies in the US annually.

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The authors declare no competing interests.

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Hao, S., Meyer, D., Klose, C. et al. Association of distance traveled on receipt of surgery in patients with locally advanced rectal cancer. Int J Colorectal Dis 38, 8 (2023). https://doi.org/10.1007/s00384-022-04300-w

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