Published Jul 15, 2021
Cancer survival rates are lower for adolescents and young adults who reside in rural areas as compared to those who live in the suburbs or city.
Those individuals are also more likely to be diagnosed with cancer when the disease is at a later stage, according to a new study published in the medical journal Cancer that examined the role geography plays in cancer survival rates.
“The findings indicate that [adolescents and young adults] living in rural versus metropolitan US counties and those living farther from the diagnosis reporting hospital are more likely to be diagnosed at a later cancer stage, when it is generally less treatable, and have lower survival compared with [adolescents and young adults] living in metropolitan counties,” according to the study.
Researchers used diagnosis stage and survival data from the National Cancer Database for the study. Subjects were then placed into three groups. The first grouping was based on their proximity to a city at time of diagnosis, and classified as: rural, metropolitan, and urban. The second was based on their proximity to a hospital when they were diagnosed, which was recorded as: short (less than 12.5 miles), intermediate (between 12.5 and 50 miles) or long (more than 50 miles).
Patients residing in rural areas were 1.16 times more likely to have a late-stage diagnosis compared to those living in urban areas, while living a “long distance” from the hospital corresponded to a 1.20 times greater risk of being diagnosed as stage III or stage IV versus those who were only a “short distance.”
Place of residence had an even bigger impact on cancer survival rates among adolescents and young adults.
The risk of mortality was 1.17 times greater for subjects who lived in rural areas versus metro counties, and 1.30 times higher if the patient lived a “long distance” from the medical facility as compared to a “short distance.”
Disease stage ultimately mediated 54% of the associations between metro, urban, or rural residence and survival, and 31% of the hospital proximity categories and survival.
Adolescents and young adults are a vulnerable population because cancer tends to be rare and is often not suspected. As a result, they are often not diagnosed in a timely manner which impacts cancer survival rates.
The study’s authors looked at 146,418 cancer patients for the diagnosis stage aspect of the study, and 178,688 individuals to uncover the correlation location played in cancer survival rates.
All subjects were 15 to 39 years old and had been diagnosed with cancer between 2010 and 2014.
“Hopefully, this research will draw attention to geographic disparities in AYA (adolescent and young adult) cancer survival,” said Dr. Kimberly Johnson, associate professor at Washington University and lead author of the study.
“It will be important to conduct further research to understand the mechanisms for these findings and to develop interventions to address these disparities.”
It often takes a team of doctors and specialists to guide each individual through their cancer journey, and some medical facilities have those teams already in place.
“Not everybody can get to a designated comprehensive cancer center, but the data is clear that these centers are extremely helpful–especially when your disease is complex,” Dr. Heather Yeo, colorectal surgeon and surgical oncologist at Weill Cornell Medicine , previously told SurvivorNet.
That is not to say a person cannot get quality medical care from a doctor or specialist not employed at one of these centers, stressed Dr. Yeo.
“There are plenty of excellent physicians who are not at comprehensive cancer centers. That being said, when you are looking into care, you should be asking: ‘Am I getting doctors with different specialties like medical oncology, radiation oncology, surgery, pathology and radiology?’,” noted Dr. Yeo.
“The really important thing is that you’ve got the right people and that they know the latest science. That can happen away from a major cancer center–or it can happen at one. In order to get the best guidance, you will need to ask.”
Dr Ken Miller, Director of Outpatient Oncology, University of Maryland School of Medicine, echoed much of what Dr. Yeo in a previous interview with SurvivorNet, while also stressing the attention to detail a case gets at these centers.
“Major cancer centers offer a comprehensive team-based approach to treating your lung cancer. The team includes a surgical oncologist, medical oncologist, pathologist and radiologist, as well as other specialists,” Dr. Miller pointed out.
“All of these doctors convene to form a tumor board where they discuss your case, often and in depth. These meetings assure that everyone is on the same page, and allow your team to monitor the results in real time and tweak or refine your treatment when needed.”