Abstract
Background
It is unknown whether rural patients with operable breast cancer do worse than urban
patients in Louisiana. We performed an analysis of breast cancer based on rural versus
urban residencies and evaluate factors associated with worse survival.
Methods
Data on women diagnosed with stages I to III breast cancer from 2004 to 2016 were
obtained from the Louisiana Tumor Registry. Overall survival and cancer-specific survival
were compared between rural and urban residencies by sociodemographic, clinical-pathologic,
and treatment variables. Kaplan-Meier method and the log-rank test were used to compare
the survival curves. Cox regression model was used to assess independent factors associated
with overall survival and cancer-specific survival.
Results
Of the 27,780 patients, 2,441 patients (8.7%) resided in rural areas. Compared with
urban patients, rural patients tended to be older, underinsured, more impoverished,
less likely to be treated at an American College of Surgeons accredited institution,
and more likely to be treated at a low-volume center (P < .005 each). For stages I and II diseases, there was a statistically significant difference
in overall survival favoring urban regions, but no difference in cancer-specific survival.
For stage III disease, there was no difference in either overall survival or cancer-specific
survival between the 2 cohorts. Overall survival and cancer-specific survival curves
for the entire cohort were not different at the 5-year mark, but become statistically
significant with greater time; although rural patients had a lower long-term overall
survival (P = .0001) and cancer-specific survival (P = .049) compared with urban patients, the rural-urban differences in overall survival
and cancer-specific survival were no longer different after adjusting for other covariates,
indicating the observed differences in univariate analysis were attributable to sociodemographic,
clinicpathologic, and treatment factors.
Conclusion
Despite rural patients with operable breast cancer having an overall lesser overall
survival and cancer-specific survival than their urban counterpart, rural residence
itself was not an independent predictor of outcome. In fact, particular socioeconomic
factors increased the risk of death among patients residing in rural areas. Additional
analysis at the patient-level is needed to understand the interactions between rurality
and breast cancer outcomes in Louisiana.
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Article info
Publication history
Published online: July 01, 2020
Accepted:
April 20,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
