Researchers have previously found that patients with cancer who live in more rural locations have worse outcomes than those from urban places. However, it isn’t clear what causes this pattern. To investigate the issue further, a research team led by Dr Joseph Unger has compared the health outcomes of rural and urban cancer patients who received similar clinical care. They found that, when this factor was controlled for, the two groups had similar outcomes. To read more about this, you can find the original study at JAMA Network Open.
The Study Design
To find out whether patients in rural and urban areas have similar outcomes if they receive the same care, researchers analyzed data from patients taking part in clinical trials. Since clinical trials are designed to give patients a certain type of care, all patients, regardless of where they live, should have received similar treatment. Almost thirty-seven thousand patients were included in this study. They came from all fifty states and were enrolled in clinical trials that took place between 1986 and 2012.
The Results
The researchers found that patients from rural and urban areas usually had similar outcomes if they received similar medical care. Out of seventeen analysis cohorts, only one rural group (patients with a certain type of breast cancer) showed statistically significantly worse survival. This remained true even when the researchers tried different definitions of ‘rural’.
The Researchers’ Conclusions
Based on these results, the researchers say that helping patients from all areas to access similar levels of care could help to reduce the difference in cancer outcomes between patients in rural and urban areas. In their article, they cite previous research that has shown that rural patients often have less access to medical care compared to urban patients. According to one study, despite around 20% of people in the US living in rural places, only 3% of oncologists work in these areas. This may mean that patients need to travel much further than patients living in bigger towns and cities to receive treatment, and this added challenge of time and cost, the researchers say, may mean that rural patients receive a different standard of care. For example, they reference this study, which found that patients with early-stage breast cancer from rural areas underwent breast-conserving therapy at much lower rates than the national average.
The researchers concluded, “Improving access to uniform treatment strategies […] may help resolve the disparity in cancer outcomes between rural and urban patients.”
