Abstract 1470P
Background
Advanced gastroesophageal cancers (AGCs) are aggressive and require multidisciplinary, tertiary care. We hypothesized that access to such care may differ between urban and rural patients. This study aimed to describe urban vs. rural patterns of referrals, treatments, and outcomes for a real-world, population-based cohort of patients with AGCs.
Methods
All patients diagnosed with AGCs from 2010 to 2017 in Alberta, Canada were identified from the province’s cancer registry. Each patient’s postal code was linked to the census tract to determine urban vs. rural residence. Data on time from referral to consultation and treatment modality were collated. Logistic and Cox regression were used to determine the associations of urban vs. rural status with referral plus treatment and overall survival (OS), respectively.
Results
A total of 1244 patients were included: median age was 67 (IQR 58-78) years, 72% were men, 633 (51%) had gastric and 611 (49%) had esophageal cancer. In this cohort, 87%, 80%, and 44% were referred to a cancer center, seen by an oncologist, and treated, respectively. Among referred patients, 73%, 24%, and 3% were from urban, rural, and unknown settings respectively. Median time from referral to consult was 11 days for both urban and rural populations (p=0.05). Patients with fewer hospitalizations waited 9 days from referral to consult compared to 13 days for individuals with more hospitalizations (p<0.001). Rural patients were less likely to be referred (OR 0.442, 95% CI 0.269-0.725, p=0.001) and treated (OR 0.643, 95% CI 0.426-0.971, p=0.036) whereas hospitalized patients (OR 2.855, 95% CI 1.158-7.042, p=0.023) and those with longer hospital stays (OR 2.728, 95% CI 1.603-4.644, p<0.001) were more likely to be referred. All patients experienced a poor prognosis, irrespective of urban vs. rural (HR 1.169, 95% CI 0.986-1.386, p=0.072) and hospitalization (HR 0.993, 95% CI 0.824-1.198, p=0.945) status.
Conclusions
Rural patients with AGCs face potential access barriers due to geography. By the time that patients are hospitalized, referral and treatment still translated to poor survival. Prompt referral and entry into the cancer care system is essential, particularly for patients who live remotely.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.