Geographic factors linked to cancer diagnosis, survival among adolescents, young adults
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Adolescents and young adults with cancer who lived in rural areas and farther from the reporting hospital appeared more likely to be diagnosed with later-stage disease and have shorter survival, according to a study published in Cancer.
“Geographic residence (rural vs. urban) can influence cancer mortality and it can be more difficult to access health care for rural populations,” Kimberly J. Johnson, MD, PhD, associate professor and cancer epidemiologist at Brown School at Washington University in St. Louis, told Healio. “However, there has been no prior research on how geographic factors influence cancer survival in the AYA [adolescent and young adult] population, which is vulnerable to worse health outcomes than other populations due to lower health insurance rates and other factors that may make access to care even more challenging.”
Researchers gathered data from the National Cancer Database on AYAs aged 15 to 39 years diagnosed with cancer from 2010 to 2014. The survival analysis included 178,688 AYAs, of whom 146,418 (64.2% female, 38.4% aged 35-39 years; 68.4% white) were included in the stage analysis.
Researchers used Rural-Urban Continuum Codes to define metropolitan, urban or rural counties at time of diagnosis, and they classified the distance between patients’ residence and the reporting hospital as short ( 2.5 miles), intermediate (> 12.5 to < 50 miles) or long ( 50 miles).
Results showed odds of a late-stage diagnosis (stage III-IV vs. stage I-II) were 1.16 (95% CI, 1.05-1.29) times greater for AYAs residing in rural counties compared with metropolitan counties and 1.2 (95% CI, 1.16-1.25) times greater for AYAs living long vs. short distances from the reporting hospital. Additionally, the hazard of death was 1.17 (95% CI, 1.05-1.31) times greater for those living in rural vs. metropolitan counties and 1.3 (95% CI, 1.25-1.36) times greater for long vs. short distances to the hospital.
“We need to do more research to understand why we see these patterns,” Johnson said. “AYAs living farther from cancer specialists may have their cancers detected later and have a harder time obtaining optimal treatment. If we understand why, we can potentially develop interventions to improve cancer care for this population.”
One surprising finding, Johnson added, was that patients with central nervous system tumors traveling farther for care had longer survival, contrasting much of the study’s data. Johnson said research looking into CNS in AYAs is currently underway.
Limitations of the study included the National Cancer Database’s inability to capture cancer-specific survival, the low number of patients with rural residences (n = 1,923) and the researchers’ inability to determine the impact of diagnosis facility type (academic center, NCI-designated comprehensive cancer center, etc.) on some results.
Johnson believes strategies and action plans should be implemented to address the disparities faced by AYAs with cancer.
“First, I think policy strategies are needed to help ensure AYAs have equitable access to care. Health insurance may be a factor that could be addressed at the policy level,” she said. “Unfortunately, there is political resistance to ensuring that all Americans, including AYAs, have affordable health insurance.
“Second, we need to ensure that rural Americans have access to quality health care. According to Becker’s Hospital Review’s CFO report, rural hospital closings are occurring at a record pace. This is bound to further impact the health of rural Americans if we cannot figure out a way to ensure their viability.”
For more information:
Kimberly J. Johnson, MD, PhD, can be reached at Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St Louis, MO 63130; email: kijohnson@wustl.edu.
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