Rurality and cancer surgery in the United States

Markin, Abraham; Habermann, Elizabeth B.; Chow, Christopher J.; Zhu, Yanrong; Vickers, Selwyn M.; Al‐Refaie, Waddah B.

doi:10.1016/j.amjsurg.2012.07.012

Cited by 28 publications

(37 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, we cannot directly comment on the structural factors that may have contributed to the suboptimal number of lymph nodes examined in rural patients, but this finding certainly should be further investigated. Our group has in another study explored the impact of treatment location on outcomes, 11 but were conversely unable to assess the role of patient residence in that study.…”

Section: Discussionmentioning

confidence: 98%

“…8–10 We have previously explored the impact of the location of treatment on outcomes, specifically demonstrating that treatment at a rural hospital did not confer worse surgical mortality except for in patients with complex cancers. 11 However, an effective appraisal of quality cancer care should more broadly consider the structures, processes and outcomes of cancer care. 12 While colon cancer represents the third most common cancer in the US, investigation into the impact of rural residence across the entire continuum of colon cancer care has been sparse.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Does Patient Rurality Predict Quality Colon Cancer Care?

Chow

Al‐Refaie

Abraham

et al. 2015

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

Background Over fifty million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized, despite its known impact on screening. Objective Our study sought to examine the impact of patient rurality on quality and comprehensive colon cancer care. Design Using the 1996–2008 California Cancer Registry, we constructed a retrospective cohort of 123,129 patients with stage 0–IV colon cancer. Rural residence was established based on the patient’s medical service study area designated by the registry. Patients All patients diagnosed between 1996–2008 with tumors located in the colon were eligible for inclusion in this study. Main Outcome Measures Baseline characteristics were compared by rurality status. Multivariate regression models then were used to examine the impact of rurality on stage in the entire cohort, adequate lymphadenectomy in stage I–III disease and receipt of chemotherapy for stage III disease. Proportional hazards regression was used to examine the impact of rurality on cancer specific survival. Results Of all patients diagnosed with colon cancer, 18,735 (15%) resided in rural areas. Our multivariate models demonstrate that rurality was associated with later stage of diagnosis, inadequate lymphadenectomy in stage I–III disease and lower likelihood of receiving chemotherapy for stage III disease. In addition, rurality was associated with worse cancer specific survival. Limitations We could not account for socioeconomic status directly, though we used insurance status as one surrogate. Furthermore, we did not have access to treatment location or distance traveled. We also could not account for provider or hospital case volume, patient comorbidities nor complications. Conclusions A significant portion of patients treated for colon cancer live in rural areas. Yet, rural residence is associated with modest differences in stage, adherence to quality measures and survival. Future endeavors should help improve care to this vulnerable population (see SDC1: video abstract).

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Does Patient Rurality Predict Quality Colon Cancer Care?

Chow

Al‐Refaie

Abraham

et al. 2015

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

show abstract

“…We believe that our matched propensity score analysis maximized causal inferences. 11 Rigorous nonrandomized evaluations are needed to determine which patients benefit from RAS approaches. 28 High-quality observational studies can provide information on treatment effectiveness in particular subpopulations.…”

Section: Discussionmentioning

confidence: 99%

“…10 Moreover, the prevalence of obesity in colon cancer patients continues to be large and is a significant burden on the healthcare system. 11 …”

Section: Introductionmentioning

confidence: 99%

Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy

Schootman

Hendren

Loux

et al. 2017

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Background We compared patient outcomes of robot-assisted surgery (RAS) and laparoscopic colectomy without robotic assistance for colon cancer or nonmalignant polyps, comparing all patients, obese versus non-obese patients, and male versus female patients. Methods We used the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program data to examine a composite outcome score comprised of mortality, readmission, re-operation, wound infection, bleeding transfusion, and prolonged postoperative ileus. We used propensity scores to assess potential heterogeneous treatment effects of RAS by patient obesity and sex. Results In all, 17.1% of 10,844 of patients received RAS. Males were slightly more likely to receive RAS. Obese patients were equally likely to receive RAS as non-obese patients. In comparison to nonRAS, RAS was associated with a 3.1% higher adverse composite outcome score. Mortality, reoperations, wound infections, sepsis, pulmonary embolisms, deep vein thrombosis, myocardial infarction, blood transfusions, and average length of hospitalization were similar in both groups. Conversion to open surgery was 10.1% lower in RAS versus nonRAS patients, but RAS patients were in the operating room an average of 52.4 minutes longer. We found no statistically significant differences (p > 0.05) by obesity status and gender. Conclusions Worse patient outcomes and no differential improvement by sex or obesity suggest more cautious adoption of RAS.

show abstract

“…After controlling for other factors, patients in rural settings are less likely to have an appropriate bariatric surgery evaluation and treatment compared to those in urban areas (16). In addition, rural hospitals have significantly higher mortality rates among patients undergoing complex cancer surgery (17). And overall, individuals living in rural areas are also likely to be described by other social characteristics known to be associated with worse health outcomes, including minority status, low socioeconomic status, older age, public insurance, and greater comorbidity (16).…”

Section: Current Conditionsmentioning

confidence: 99%

Socially Responsible Surgery: Building Recognition and Coalition

et al. 2017

View full text Add to dashboard Cite

ImportanceSocially responsible surgery (SRS) integrates surgery and public health, providing a framework for research, advocacy, education, and clinical practice to address the social barriers of health that decrease surgical access and worsen surgical outcomes in underserved patient populations. These patients face disparities in both health and in health care, which can be effectively addressed by surgeons in collaboration with allied health professionals.ObjectiveWe reviewed the current state of surgical access and outcomes of underserved populations in American rural communities, American urban communities, and in low- and middle-income countries.Evidence reviewWe searched PubMed using standardized search terms and reviewed the reference lists of highly relevant articles. We reviewed the reports of two recent global surgery commissions.ConclusionThere is an opportunity for scholarship in rural surgery, urban surgery, and global surgery to be unified under the concept of SRS. The burden of surgical disease and the challenges to management demonstrate that achieving optimal health outcomes requires more than excellent perioperative care. Surgeons can and should regularly address the social determinants of health experienced by their patients. Formalized research and training opportunities are needed to meet the growing enthusiasm among surgeons and trainees to develop their practice as socially responsible surgeons.

show abstract

Rurality and cancer surgery in the United States

Cited by 28 publications

References 14 publications

Does Patient Rurality Predict Quality Colon Cancer Care?

Does Patient Rurality Predict Quality Colon Cancer Care?

Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy

Socially Responsible Surgery: Building Recognition and Coalition

Contact Info

Product

Resources

About