Impact of Travel Distance and Urban‐Rural Status on the Multidisciplinary Management of Rectal Cancer

Loree, Jonathan M.; Javaheri, Khodadad Rasool; Lefresne, Shilo; Speers, Caroline; Ruan, Jenny Y.; Chang, Jennifer; Brown, C. J.; Kennecke, Hagen F.; Olson, Robert; Cheung, Winson Y.

doi:10.1111/jrh.12219

Cited by 36 publications

(41 citation statements)

References 23 publications

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“…The rectal cancer study also focused on the five centers of the British Columbia Cancer Agency, possibly suggesting that the distributed model of care delivery across geographically dispersed catchment areas in the province that has been adopted by British Columbia may be a potentially effective strategy to minimize geographical disparities. This may be particularly relevant for tumors, such as HNC and rectal cancer, that conventionally require complex multidisciplinary coordination of multiple treatment modalities …”

Section: Discussionmentioning

confidence: 99%

“…This may be particularly relevant for tumors, such as HNC and rectal cancer, that conventionally require complex multidisciplinary coordination of multiple treatment modalities. 14,27 Another reason for the lack of urban and rural disparities in survival could be that our research was undertaken in Canada, which has a publicly funded healthcare system governed by the Canadian Health Act that focuses on five pillars: public administration, comprehensiveness, universality, portability, and accessibility. 31 Provinces and territories are responsible for the organization, management, and delivery of health services within their jurisdiction, but they receive federal funding and follow federal policies.…”

Section: Discussionmentioning

confidence: 99%

“…The main explanatory variable of interest was community size, which has been previously used as a proxy measure of rurality . Using the Canadian census tract, patients were grouped into four distinct community sizes based on the postal code of their primary residence at the time of their index HNC diagnosis .…”

Section: Methodsmentioning

confidence: 99%

“…The main explanatory variable of interest was community size, which has been previously used as a proxy measure of rurality. 14,27 Using the Canadian census tract, patients were grouped into four distinct community sizes based on the postal code of their primary residence at the time of their index HNC diagnosis. 28 The Canadian census classifies population centers into several categories: small urban centers (SUC) (1,000-29,999 residents), medium urban centers (MUC) (30,000-99,999 residents), and large urban centers (LUC) (100,000 1 residents).…”

Section: Definition Of Study Variablesmentioning

confidence: 99%

“…[11][12][13] Notably, recent studies have also evaluated the impact of geography on cancer outcomes by assessing the relationship between urban-rural residence and cancer survival. [14][15][16][17][18][19] The majority of research on urban-rural disparities has focused on breast, lung, and colorectal malignancies, 14,15,19 with relatively few studies assessing the impact of rurality on HNC outcomes. 16,19,20 However, management of HNC is becoming more specialized, and effective treatments frequently require multidisciplinary and multimodality care, so the impact of rurality can be significant because complex care may be suboptimal in smaller centers.…”

Section: Introductionmentioning

confidence: 99%

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Urban and rural differences in outcomes of head and neck cancer

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Definition Of Study Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Urban and rural differences in outcomes of head and neck cancer

et al. 2017

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How spatial accessibility to colonoscopy affects diagnostic adherences and adverse intestinal outcomes among the patients with positive preliminary screening findings

et al. 2020

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Background Colonoscopy is an important procedure for early colorectal cancer (CRC) detection, however, patients with positive preliminary screening results in China may not seek for colonoscopy to confirm the diagnosis. We evaluated the spatial accessibility of colonoscopy among the residents with positive preliminary screening results in Guangzhou, China, and investigated how colonoscopy accessibility was associated with the population adherence and adverse intestinal outcomes. Methods This study was based on the Guangzhou community‐based CRC screening program. Spatial accessibility was measured using three metrics including travel time from home to nearest colonoscopy hospital, physician‐to‐population ratio (PPR) and accessibility indicator estimated with enhanced two‐step floating catchment area method (E2SFCA). We used Cox regression and logistic regression to assess the association of colonoscopy accessibility with population adherence and adverse intestinal outcomes, respectively. Results A total of 34 606 people were identified with positive preliminary screening findings. Central areas were reported with higher E2SFCA scores, higher PPR and less travel time. The model adjusting for potential individual level confounders found that PPR > 50 (Hazard Ratio (HR) = 1.88, 95% Confidence Interval (CI): 1.79‐1.97) and higher scores of E2SFCA (HR = 3.78, 95% CI: 2.07‐6.92) were associated with increased adherence, although estimates were not significant in the model adjusting for both individual and district‐level confounders. For adverse intestinal outcomes, the final multilevel logistic model suggested a lower risk of intestinal lesions among the residents in areas with PPR > 50 (Odds Ratio (OR) = 0.49, 95% CI: 0.24‐0.99) and higher scores of E2SFCA (OR = 0.20, 95% CI: 0.05‐0.82). Conclusion Significant inequality of colonoscopy accessibility was observed across Guangzhou. The increased incidence of intestinal lesions was associated with spatial inequalities of medical resources. Policies against the spatial inequality in medical resources should be developed.

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Examination of risk factors for discontinuation of follow‐up care in patients with head and neck cancer

2022

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Background Little research has examined discontinuation of follow‐up care in patients with head and neck cancer. This exploratory study sought to examine key demographic, disease, and behavioral factors as possible correlates of discontinuation ( N = 512). Methods Cross‐sectional study examined correlates of discontinuation of follow‐up care within 1 year. The primary outcome was defined as a disease‐free survivor not returning to cancer clinic for two consecutive follow‐up appointments within the first year of care and not reentering oncologic care at any point thereafter. Demographic, disease, and behavioral factors were examined using multivariable logistic regression. Results One hundred twenty‐six (24.6%) patients discontinued by 12‐month follow‐up. Being unmarried (OR = 1.28, 95% CI = 1.01–1.63, p = 0.041) and having elevated depressive symptomatology (OR = 1.04, 95% CI = 1.01–1.07, p = 0.034) were significantly associated with discontinuation. Receipt of a single (vs. multimodal) treatment approached significance (OR = 1.71, 95% CI = 0.96–3.07, p = 0.071). Conclusion Approximately one quarter of patients disengaged from important follow‐up care within 1 year. Lack of social support, depressive symptomatology, and single treatment modality may be important correlates of discontinuation of care in patients with head and neck cancer. Additional studies of this outcome are needed. Improved understanding of correlates associated with discontinuation could facilitate the identification of at‐risk patients and further development of interventions to keep patients engaged at a crucial time in the survivorship care trajectory.

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Impact of Travel Distance and Urban‐Rural Status on the Multidisciplinary Management of Rectal Cancer

Abstract: In this population-based study, there were no urban-rural differences in access to multidisciplinary care, but increased distance may be associated with worse cancer-specific outcomes.

Cited by 36 publications

References 23 publications

Urban and rural differences in outcomes of head and neck cancer

Urban and rural differences in outcomes of head and neck cancer

How spatial accessibility to colonoscopy affects diagnostic adherences and adverse intestinal outcomes among the patients with positive preliminary screening findings

Examination of risk factors for discontinuation of follow‐up care in patients with head and neck cancer

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