Disparities: With Cancer Treatment, an Edge for Rural Patients

By ERIC NAGOURNEY
It seems only natural to assume that when cancer strikes people who live in rural areas, more time will pass before it is discovered than for people in cities.
In fact, a study reports, the opposite seems to be true. Urban residents are more likely to see a doctor later than those in the country are, a lapse that can make the cancers harder to treat.
Writing in the November issue of The Journal of the American College of Surgeons, researchers said the findings confounded the assumptions of many in the medical community — including doctors who work in rural areas.
“Rural surgeons are often uneasy when their outcomes are compared with those of urban surgeons,” the study says, “largely because they perceive that rural patients typically present with worse disease.”
The researchers, Dr. Ian Paquette and Dr. Samuel R. G. Finlayson of the Dartmouth-Hitchcock Medical Center, based their findings on a review of information about almost 300,000 cancer patients gathered by the National Cancer Institute.
The study looked at more than 125,000 people with colorectal cancer and more than 160,000 people with lung cancer over a three-year period. For both kinds of cancers, the researchers found, urban patients were more likely to seek treatment for the first time when they were in advanced stages of the disease.
This was true even though those cancer patients who lived in the country tended to be considerably poorer — and, in the case of the colorectal cancer patients, older — than those in the city. And people who live in cities are more likely to be near a broader range of medical services.