TY - JOUR
T1 - Rural–urban differences in surgical treatment, regional lymph node examination, and survival in endometrial cancer patients
AU - Zahnd, Whitney E.
AU - Hyon, Katherine S.
AU - Diaz-Sylvester, Paula
AU - Izadi, Sonya R.
AU - Colditz, Graham A.
AU - Brard, Laurent
N1 - Funding Information:
Research reported in this manuscript was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under Award Numbers P20CA192987 (Dr. Laurent Brard) and P20CA192966 (Ms. Sonya Izadi and Dr. Graham Colditz). Dr. Brard reports grants from NIH/NCI, during the conduct of the study.
Funding Information:
Acknowledgments Research reported in this manuscript was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under Award Numbers P20CA192987 (Dr. Laurent Brard) and P20CA192966 (Ms. Sonya Izadi and Dr. Graham Colditz).
Publisher Copyright:
© 2017, Springer International Publishing AG, part of Springer Nature.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Purpose: Endometrial cancer (EC) is the most common gynecological malignancy and one of few cancers with an increasing US mortality rate. Rural patients may have less access to specialty care affecting their receipt of surgery and adequate lymphadenectomy (AL). We sought to assess rural–urban differences in EC surgery, lymphadenectomy, and survival. Methods: We analyzed data from the Surveillance Epidemiology and End Results database on EC patients (2004–2013). We performed univariate analyses to compare rural and urban patients on demographic and clinical characteristics and receipt of nodal examination and AL. We assessed rural–urban differences in trends of receipt of AL, performed logistic regression to evaluate differences in receipt of surgery, nodal examination, and AL, and performed survival analysis. Results: Rural patients were less likely to have any lymph nodes removed, had a smaller median number removed, and a smaller proportion had AL. Even after controlling for established risk factors, rural patients had lower odds of lymph node examination and adequate AL than urban patients and also had poorer survival. Conclusions: Future research should continue to assess the association between access to care and disparities in surgical care and the effect of these disparities on survival.
AB - Purpose: Endometrial cancer (EC) is the most common gynecological malignancy and one of few cancers with an increasing US mortality rate. Rural patients may have less access to specialty care affecting their receipt of surgery and adequate lymphadenectomy (AL). We sought to assess rural–urban differences in EC surgery, lymphadenectomy, and survival. Methods: We analyzed data from the Surveillance Epidemiology and End Results database on EC patients (2004–2013). We performed univariate analyses to compare rural and urban patients on demographic and clinical characteristics and receipt of nodal examination and AL. We assessed rural–urban differences in trends of receipt of AL, performed logistic regression to evaluate differences in receipt of surgery, nodal examination, and AL, and performed survival analysis. Results: Rural patients were less likely to have any lymph nodes removed, had a smaller median number removed, and a smaller proportion had AL. Even after controlling for established risk factors, rural patients had lower odds of lymph node examination and adequate AL than urban patients and also had poorer survival. Conclusions: Future research should continue to assess the association between access to care and disparities in surgical care and the effect of these disparities on survival.
KW - Disparities
KW - Endometrial cancer
KW - Health services research
KW - Rural health
UR - http://www.scopus.com/inward/record.url?scp=85039849605&partnerID=8YFLogxK
U2 - 10.1007/s10552-017-0998-4
DO - 10.1007/s10552-017-0998-4
M3 - Article
C2 - 29282582
AN - SCOPUS:85039849605
VL - 29
SP - 221
EP - 232
JO - Cancer Causes and Control
JF - Cancer Causes and Control
SN - 0957-5243
IS - 2
ER -