Importance: Considering reported rural-urban cancer incidence and mortality trends, rural-urban cancer survival trends are important for providing a comprehensive description of cancer burden. Furthermore, little is known about rural-urban differences in survival trends by racial and ethnic groups. Objective: To examine national rural-urban trends in 5-year cancer-specific survival probabilities for lung, prostate, breast, and colorectal cancers in a diverse sample of racial and ethnic groups. Design, Setting, and Participants: This cross-sectional study used an epidemiologic assessment with 1975 to 2016 Surveillance, Epidemiology, and End Results (SEER) data to analyze patients diagnosed no later than 2011. Patients were classified as living in rural and urban counties based on the 2013 Rural-Urban Continuum Codes. Main Outcomes and Measures: The 5-year cancer-specific survival probability of urban and rural patients for each cancer type was estimated by fitting Cox proportional hazard regression models accounting for race, ethnicity, tumor characteristics, and other sociodemographic characteristics. A generalized linear regression model was used to estimate the mean estimated probability of survival for each stratum. Joinpoint regression analysis estimated periods of significant change in survival. Results: In this study, data from 3659417 patients with cancer (median [IQR] age, 67 [58-76]; 1 918 609 [52.4%] male; 237 815 [6.5%] Hispanic patients; 396 790 [10.8%] Black patients; 2 825 037 [77.2%] White patients) were analyzed, including 888338 patients with lung cancer (24.3%), 750704 patients with colorectal cancer (20.5%), 987826 patients with breast cancer (27.0%) breast, and 1023549 patients with prostate cancer (28.0%). There were 430353 rural patients (11.8%). Overall, there was an equal representation of rural and urban men. Rural patients were likely to be non-Hispanic White individuals, have more cases of distant tumors, and be older. Rural and non-Hispanic Black patients for all cancer types often had shorter survival. From 1975 to 2016, the 5-year lung cancer survival rate was shorter for non-Hispanic Black rural patients in 1975 at 48%, while increasing to 57% for both non-Hispanic Black urban and rural patients in 2011, but still the shortest among all cancer types. In 1975, the longest survival rate was observed in urban Asian and Pacific Islander patients with breast cancer at 86%, and in 2011, the longest survival rate was observed in urban non-Hispanic White patients with XX cancer at 92%. Conclusions and Relevance: Even after accounting for sociodemographic and tumor characteristics, these findings suggest that non-Hispanic Black patients with cancer are particularly vulnerable to cancer burden, and resources are urgently needed to reverse decades-old survival trends..
|Journal||JAMA network open|
|State||Published - May 19 2022|
Bibliographical noteFunding Information:
Funding/Support: Dr Lewis-Thames was supported grant UL1TR001422 from the Northwestern University Clinical and Translational Sciences Institute, grant RHA2020-01 Respiratory Health Association of Metropolitan Chicago, grant K01CA262342 from the National Cancer Institute, grant P30AG059988 from the National Institutes of Health's National Institute on Aging, and funds from the Northwestern University Center for Community Health. Dr Khan was supported by grant W81XWH-18-1-0168 from US the Department of Defense Prostate Cancer Research Program. Dr Moore was supported by grant K01MD015304 from the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Dr Langston was supported by grant K12DK111028 from the National Institute of Diabetes and Digestive and Kidney of the National Institutes of Health.
services.8-10,20,24,25 Targeted programming for rural cancer survival will have tempered effects without targeted programming focusing on rural care across the cancer continuum. Yet, funding through the National Cancer Institute R-series grants addressing rural cancer control and management remains low.1 Furthermore, funded grants focused solely on rural populations, rather than rural-urban differences, are even less. Although existing funding facilitates limited growth in rural cancer research, policy reform targeting rural cancer control remains minimal. In 2020, the American Society of Clinical Oncology released a policy statement that identified that persistent inequities and rural cancer burden support the development and advancement of programs that improve financing for cancer care and interventions that improve access to care.26 Additional research, programming, financial resources, and policy changes are needed to comprehensively address rural-urban cancer disparities along the cancer continuum. This study has several strengths, including that this is the first comprehensive decades-long descriptive study of rural-urban 5-year survival across multiple common cancer types in rural areas. We intend to generate hypotheses related to the comprehensive observation of rural-urban disparities trend over time, thus informing future investigations and policies. To supplement this data, future studies that explore the role of both modifiable factors (access to care11,27,28 [eg, broadband internet, treatment modalities] and health behaviors [eg, sun exposure, smoking behaviors]17,29), and nonmodifiable factors (socioeconomic status30-32 [eg, poverty, occupation]) in survival trends are warranted.
Conflict of Interest Disclosures: Dr Khan reported receiving grants from the US Department of Defense outside the submitted work. No other disclosures were reported.
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ASJC Scopus subject areas
- Medicine (all)