For Colon Cancer Treatment, Living in City a Plus

Reported by Tiffany Chao, M.D.

New research shows that patents with colon cancer, one of the leading causes of death in the United States, may have worse outcomes if they live in a rural area.

The new study, presented Wednesday at the American College of Surgeons 2012 Annual Clinical Congress, showed that patients living in rural areas are more likely to be diagnosed late and receive inferior treatment compared with those patients living in urban areas. Overall, rural colon cancer patients are more likely to die from their colon cancer as well.

"Patients sometimes travel hours to get to their operations, radiation, and chemotherapy," said Dr. Christopher Chow, a surgery resident at the University of Minnesota and lead author of the study, in a statement. "We wanted to know if that factor was a barrier to receiving care. We wanted to look at what happens with rural patients at various stages of the process."

Outcomes in colon cancer are affected to some extent by a patient's race and insurance status, but this is the first study to demonstrate that outcomes are affected by where a patient lives.

This study of over 123,000 patients was conducted on patients diagnosed with colon cancer between 1996 and 2008. Patients who lived in rural areas comprised about 15 percent of the overall total. These patients were 4 percent more likely to receive a late-stage diagnosis - that is, being found in stage III or IV - compared to patients who lived in urban areas.

In addition, they had 17 percent lower odds of receiving chemotherapy than urban patients, and 18 percent lower chance of having an adequate number of lymph nodes removed during their operations. This insufficient lymph node removal may indicate that the surgery was inadequate -surgeons may consider adequate lymph node removal as a surrogate marker for how the complete the operation was.

Overall, rural patients had a 5 percent higher risk of death from colon cancer compared with urban patients.

"These findings do not mean that if you're a rural patient and you've been diagnosed with colon cancer [that] you should move," Chow said. "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'."