Survival disparities between rural, urban cancer patients cut when enrolled in clinical trials


The differences in survival rates between rural and urban cancer patients are significantly reduced when patients are enrolled in a cancer clinical trial, a study published in JAMA Network Open found.

CDC statistics show a significant disparity in cancer deaths. Between 2011 and 2015, 180 people out of 100,000 died of cancer in rural areas, compared to 158 people out of 100,000 in urban areas.

The analysis by SWOG, an international cancer clinical trials network formerly called the Southwest Oncology Group that is funded by the National Cancer Institute, found the difference in survival rates is due to the types of care these patients receive.

"These findings were a surprise, since we thought we might find the same disparities others had found," study author Joseph Unger, PhD, said in a news release. "But clinical trials are a key difference here. In trials, patients are uniformly assessed, treated and followed under a strict, guideline-driven protocol. This suggests that giving people with cancer access to uniform treatment strategies could help resolve the disparities in outcomes that we see between rural and urban patients."

The research team identified about 37,000 patients who enrolled in 44 SWOG phase II or III treatment trials between 1986 and 2012. The patients came from all 50 states and represented 17 different cancer types. The researchers restricted their analysis of survival to the first five years after trial enrollment to highlight outcomes associated with cancer and its treatment.

The researchers used U.S. Department of Agriculture population classifications to categorize patients as either rural or urban and evaluated their outcomes. Patient outcomes included: overall survival, or how long patients lived; progression-free survival, or how long patients lived before their cancer came back; and cancer-specific survival, or how long patients lived without dying from cancer.

The study found no meaningful difference in survival patterns between rural and urban patients for nearly all the 17 different cancer types. The researchers found an exception for patients with a specific kind of breast cancer. Rural patients with this cancer did not live as long as urban patients with this cancer, which could be linked to timely access to follow-up chemotherapy after the first round of cancer treatment, the researchers said.

"If people diagnosed with cancer, regardless of where they live, receive similar care and have similar outcomes, then a reasonable inference is that the best way to improve outcomes for rural patients is to improve their access to quality care," Dr. Unger said.

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