Are Access Costs and Income Associated With Treatment Decision-Making and Clinical Outcomes in Rural Patients...

Area of Science:

• Oncology
• Health Services Research
• Rural Health

Background:

• Limited research exists on the economic factors influencing treatment decisions and outcomes for rural patients with upper gastrointestinal malignancies.
• Understanding the relationship between access costs, patient income, and treatment choices is crucial for addressing healthcare disparities in rural populations.

Purpose of the Study:

• To investigate the impact of access costs and patient income on treatment modalities and survival rates in rural patients with upper gastrointestinal cancers.
• To explore the price elasticity of demand for cancer care services among rural populations.

Main Methods:

• Utilized the National Cancer Database (NCDB) to identify rural patients diagnosed with stages I-III esophageal, stomach, pancreatic, hepatocellular carcinoma (HCC), or cholangiocarcinoma from 2004-2020.
• Defined access cost as a function of travel distance, regional gas prices, and vehicle fuel efficiency. Patients were categorized into highest (HAC) and lowest (LAC) access cost quintiles and further stratified by income quartile.
• Compared treatment patterns and survival outcomes between high-income/high-access-cost (HI/HAC), high-income/low-access-cost (HI/LAC), low-income/high-access-cost (LI/HAC), and low-income/low-access-cost (LI/LAC) cohorts.

Main Results:

• A total of 9,582 rural patients were analyzed, with a median access cost of $26.61.
• Patients in the HI/HAC cohort were more likely to receive treatment at academic centers, undergo neoadjuvant chemotherapy, surgical resection, and liver transplantation for HCC compared to other cohorts.
• The HI/HAC group also demonstrated significantly higher 5-year overall survival rates (42.4%) compared to HI/LAC (25.6%), LI/HAC (32.2%), and LI/LAC (19.0%) cohorts (all p < 0.01).

Conclusions:

• Access cost and patient income significantly influence treatment decisions and outcomes for rural patients with upper gastrointestinal malignancies.
• Patients with higher access costs, who are willing and able to incur travel expenses, tend to receive more aggressive treatment and experience improved survival.
• Findings suggest a notable price elasticity of demand for cancer care services, highlighting potential barriers to timely and effective treatment in rural areas.