Rural Cancer Patients Get to the Doctor Earlier than City Dwellers


LEBANON, N.H., Nov. 21 -- Patients who live in urban areas were significantly more likely to present with late-stage colorectal or lung cancer than those who live in rural areas (P0.001), researchers here found.
Action Points
Explain to interested patients that people from rural areas do not actually take a longer time to visit the doctor than their urban counterparts as had been previously believed.
Explain to interested patients that people who live in cities are actually more likely than their rural counterparts to present with late-stage colon or lung cancer.
Explain to interested patients that it is important to discuss personal cancer risks and screening guidelines with their doctor.
"Rural residence should not be assumed to be a proxy for advanced patient disease associated with poor outcomes," said Samuel R.G. Finlayson, M.D. M.P.H., of Dartmouth, reporting on his study in the November issue of the Journal of the American College of Surgeons.
Dr. Finlayson and co-author Ian Paquette, M.D., of Dartmouth-Hitchcock Medical Center, looked at more than 125,000 people with colorectal cancer and more than 160,000 people with lung cancer who were drawn from the 2000 to 2003 National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. They used the rural-urban continuum codes from the U.S. Department of Agriculture to determine rural versus urban designations.
Using an ordinal logistic regression model, the research duo then compared stages at presentation between rural and urban colorectal and lung cancer patients while controlling for other factors associated with late-stage presentation, including age, race, gender, marital status, income level, and level of education.
When compared with urbanites, rural patients were slightly more likely to present with a stage I or stage II colon cancer, and slightly less likely to present with stage III or IV colon cancer.
Those odds were even a bit better when it came to lung cancer. Compared with urban patients, country dwellers were more likely to present with stage I disease (22.81% versus 21.59%) and less likely to present with stage IV disease (41.18% versus 42.90%).
Other factors, including race, socioeconomic status, age, and divorce do tend to predict when a patient will present with colorectal or lung cancer, the study showed. For example, low income status, African-American race, age less than 65, divorce, male gender, and being from a language-isolated community are associated with presenting with stage IV colon cancer, the researchers said. Being African-American, divorced, male and hailing from a language-isolated community are associated with having stage IV lung cancer at the time of diagnosis.
The researchers found some other differences between cancer patients based on where they live: rural patients with colorectal cancer tended to be older and poorer than their urban counterparts. By contrast, city-dwelling colorectal patients were more likely to come from language-isolated communities, be African-American, and be divorced.
Rural lung cancer patients were more likely to be younger, male, and substantially poorer than their urban counterparts. By contrast, urban lung cancer patients were more likely to be African-American, divorced, and come from a language-isolated community, the study showed.
They did note limitations to the study. Among them was the fact that there has been no uniform way to define rurality in different studies and databases. They also noted a limitation based on the number of unstaged cancer patients. However, they said that although the absolute numbers of urban patients with unstaged cancer were substantially higher, a higher percentage of rural patients had unstaged disease.
The researchers said their study calls into question the effectiveness of current screening recommendations and practices.
The numbers of patients presenting with advanced stage cancers is "alarming," the study authors concluded. "This observation raises questions about how well screening is implemented in urban versus rural areas, and the overall effectiveness of cancer screening to prevent late-stage presentation, [and] highlights the need for better screening efforts for colorectal cancer and the need to develop an effective screening program for people at high risk for lung cancer."
Neither of the study authors reported any conflicts of interest.Primary source: Journal of the American College of SurgeonsSource reference: Paquette I, Finlayson S, "Rural versus urban colorectal and lung cancer patients: differences in stage at presentation"J Am Coll Surg 2007; DOI: 10.1016/j.jamcollsurg.2007.04.043.