Perioperative Outcomes of Rural-Dwelling Patients Undergoing Lung and Colon Cancer Operations in Rural Facilities

Patients with cancer in rural areas often encounter significant barriers to accessing cancer care. This study evaluated whether Medicare-aged patients can safely undergo lung and colon cancer surgery at their local rural hospital, limiting travel burden.

Surveillance, Epidemiology, and End Results-Medicare files were used to identify patients with stage I to III colon and lung cancers. Patients residing in ZIP codes outside metropolitan statistical areas were defined as rural; facilities were similarly categorized. Rural patients undergoing elective colon or lung cancer surgery at rural vs urban facilities were compared. Unadjusted and risk-adjusted complication and mortality rates were compared using multivariate logistic regression. Driving distances between patients' residences and surgery facilities were calculated on the basis of ZIP codes.

A total of 10,383 rural patients with colon cancer and 6,006 rural patients with lung cancer were identified. There were no clinically significant differences between rural and urban treatment groups in either colon or lung cohorts in terms of demographics or cancer stage; their comorbidity risks were similar. Mortality and complication rates were comparable across urban and rural facilities. Travel distance was significantly greater for patients treated at urban facilities than for those treated at rural facilities for patients with colon cancer (49 vs 16 miles, p < 0.001) and lung cancer (61 vs 35 miles, p < 0.001).

Rural patients can achieve comparable short-term surgical outcomes for lung and colon cancer when treated at local rural facilities, thereby decreasing the travel burden of treatment at higher-volume urban facilities.