Where Patients Live, and How, May Influence Stage at Diagnosis of Colorectal Cancer
Posted: Wednesday, November 13, 2019
Data analysis revealed a discouraging collection of factors that appear to impact late-stage versus earlier-stage diagnosis of colorectal cancer in the United States, and among them is residence in a remote, small, rural county. David V. Evans, MD, of the University of Washington School of Medicine, Seattle, and colleagues set out specifically to examine the effect of geographic location; however, the team ultimately found that having no health insurance “appears to be the most significant predictor of stage IV diagnosis,” they reported in The Journal of Rural Health.
“These differences have persisted over time and suggest areas for further research, patient engagement, and education,” the study authors concluded.
The investigators utilized the 2010–2014 Surveillance, Epidemiology, and End Results Incidence data set, stratifying 132,277 patients with colorectal cancer by county of residence and urban influence codes into five categories (metro, adjacent micropolitan, nonadjacent micropolitan, small rural, and remote small rural). After adjustment, the percentages of patients with colorectal cancer diagnosed at stage IV versus earlier stages ranged from a low of 19.3% in the metro counties to a high of 22.7% in those categorized as remote small rural (P = .011).
The most rural areas may have a “lack of access to screening services,” noted Dr. Evans and colleagues. “The recent decline in the United States of more accessible screening modalities like fecal occult blood testing in favor of less accessible colonoscopy may aggravate this screening disparity.” More encouraging is that since the Affordable Care Act was passed, a trend toward diagnosing cancers at earlier stages is apparent in Medicaid expansion states, the authors wrote.
Regional practice variations and personal patient characteristics seem to play a role in late-stage colorectal cancer diagnosis, too. The researchers found, for instance, that younger patients, black patients, and single or widowed patients were all more likely to present with stage IV colorectal cancer.
Disclosure: The study authors reported no conflicts of interest.