SSO 2022 Press Release – Disparate Survival for Colorectal Cancer in Rural vs Urban Populations Is Not Explained by Lack of Receipt of Guideline-concordant Therapy

(Dallas—March 12, 8:40 a.m.) — Receipt of guideline-concordant therapy does not appear to differ drastically between urban and rural patients, but rural patients have decreased survival for non-metastatic colorectal cancer compared to urban-dwelling patients, according to research presented at the Society of Surgical Oncology 2022 International Conference on Surgical Care.

Prior studies have reported superior colorectal cancer survival outcomes for urban patients relative to rural populations.  Tyler J. Mouw, MD, from the University of Louisville, Louisville, Ky., hypothesized that differences in receipt of guideline-concordant therapy between these two outcomes may contribute to this difference.

Guideline-concordant therapy (GCT) was defined as documentation of surgery alone for localized colon (stage 1-2) and rectal (stage 1) cancers, surgery with adjuvant chemotherapy for stage 3 colon cancer, or surgery, chemotherapy, and radiation therapy for stage 2-3 rectal cancer.  Need for multimodal therapy (MMT) was defined by having stage 3 colon or stage 2-3 rectal cancer.

Dr. Mouw queried the National Cancer Database for records with stage 1-3 colon and rectal cancer.

Dr. Mouw and his team analyzed 325,756 records and found that, compared to urban patients, rural patients had a higher proportion of white race (91.2% vs 86.2%, p< 0.01), traveled further for treatment (median 46.7 vs 8.2 miles, p< 0.01), were more likely to live in a lowest income area (39.0 vs 16.1%, p< 0.01), but had similar rates of need of MMT (48.4% vs 45.9%).

Failure to receive guideline-concordant therapy was higher for non-white patients (75.1% vs 77.9%, p< 0.01), non-private insurance (74.3% vs 83.3%, p< 0.01), rectal vs colon cancers (36.9% vs 64.8% p< 0.01), and patients who required MMT (61.5% vs 91.0%, p< 0.01). The rate of guideline-concordant therapy was overall similar between urban and rural patients (79.4% vs 77.3%, p< 0.01), but did fluctuate with differences in travel distance.

The researchers found that patients from rural county were more likely to receive GCT compared to urban (OR 1.33, 95% CI 1.23-1.43, p< 0.01). However, when overall survival was compared between urban and rural patients, survival was better for urban patients compared to rural patients (median 111.1 vs 93.7 months, p< 0.01).

“Additional unmeasured social determinants of health likely contribute to the disparate survival outcomes between these two populations,” Dr. Mouw reported.

About the Society of Surgical Oncology

The Society of Surgical Oncology is a dynamic global community of cancer surgeons shaping advancements in the profession to deliver the highest quality surgical care for cancer patients. SSO promotes leading-edge research, quality standards and knowledge exchange, connecting cancer surgeons worldwide to continuously improve cancer outcomes. Our highly regarded educational resources, the Society’s clinical journal, Annals of Surgical Oncology and events, including SSO 2022 – International Conference on Surgical Cancer Care, inspire members and spur each cancer surgeon to grow, improve and thrive.