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Worse Function and Symptoms Among the Most Rural Patients With Advanced Cancer: A Cross-Sectional Analysis
Kathryn H Schmitz1, Stephen Baker1, Mohamed Ahmed1
1Division of Hematology Oncology, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.
Introduction:
Patients with cancer living in rural areas face unique challenges in accessing comprehensive care. Limited research has characterized disparities between patients living in more versus less remotely rural areas. This study investigated differences in health outcomes between patients with advanced cancer residing in more versus less rural areas.
Methods:
A baseline cross-sectional survey was collected as part of the Nurse AMIE study (NCT04673019). Rurality was defined using Rural Urban Commuting Area (RUCA) codes and the dichotomy for analysis was < 7 (micropolitan) versus 7-10 (small town/rural). Participants completed surveys (PROMIS; SF-36) and Short Physical Performance Battery (SPPB) assessments.
Results:
348 patients with advanced cancer from micropolitan (n = 263) and small town/rural areas (n = 85) with multiple cancer types were included. Half the sample are men (52%), 95% are white, 49% have a high school education or less, and 46% are living on $50,000 or less annually. PROMIS scores showed small town/rural residents had greater sleep disturbance (adjusted mean difference, -2.50; 95% CI, -4.46, -0.54; p = 0.013). SF-36 measures revealed worse physical functioning (adjusted mean difference, 7.69; 95% CI, 0.54, 14.84; p = 0.035), pain (adjusted mean difference, 7.37; 95% CI, 0.61, 14.13; p = 0.033), general health perceptions (adjusted mean difference, 6.78; 95% CI, 1.22, 12.34; p = 0.017), social functioning (adjusted mean difference, 7.50; 95% CI, 0.39, 14.61; p = 0.039), and energy/fatigue (adjusted mean difference, 6.77; 95% CI, 0.53, 13.00; p = 0.034) among small town/rural residents. While overall SPPB scores were not statistically significantly different, small town/rural residents performed worse on chair stands (adjusted mean difference, 0.46; 95% CI, 0.12, 0.81; p = 0.009).
Conclusion:
Patients with cancer in more rural areas experience worse health across multiple domains, consistent with gaps in cancer care delivery between more versus less rural environments. The findings underscore the need for targeted interventions to address intra-rural health disparities in cancer care and survivorship.
Trial Registration:
ClinicalTrials.gov identifier: NCT05221606.
