PATIENT REMOTENESS FROM URBAN CENTRE DOES NOT IMPACT GASTRIC CANCER OUTCOMES IN THE CONTEXT OF AN ESTABLISHED CARE CORRIDOR TO A SPECIALIST MULTIDISCIPLINARY CANCER CENTRE
Anitha Kammili*, Dominique Morency, Kyle Zullo, Saleh Almatar, Lina Abdrabo, Aya Siblini, Jonathan Cools-Lartigue, Lorenzo E. Ferri, Carmen L. Mueller
Thoracic and Upper Gastrointestinal Surgery, McGill University Health Center, Montreal, QC, Canada
Background
Patients living in rural communities experience difficulty accessing specialized medical care. For cancer patients, this has been related to more advanced disease stage at presentation, reduced access to multidisciplinary treatment and poorer overall survival (OS) in comparison to urban patients. Establishing care corridors to tertiary treatment centers may overcome logistical barriers in cancer care delivery. The aim of this study was to evaluate outcomes of gastric cancer patients living in rural and remote (R) versus urban and suburban (U) communities in the context of an established care corridor to a multidisciplinary specialist cancer center.
Methods
All patients with gastric cancer treated between 2010-2018 were identified from a prospectively collected database. Programs were in place to provide travel, lodging and cancer care coordination for remote patients throughout the study period. Remoteness index (RI) (composite measure of community size and distance from major cities as a continuous variable) for each census subdivision was obtained from federal statistics data. RI<0.1 was defined as U; RI≥0.1 comprised R. Overall survival was calculated using cancer registry data. Mann–Whitney U, Fisher Exact and χ2 tests were used to compare groups. Data are presented as median [interquartile range].
Results
A total of 283 patients were treated during the study period (U: 226(80%), R: 57(20%)). Patients in rural and remote areas were younger (U: 69 years [61-78], R: 63 years [57-74]; p=0.012), but all other baseline patient characteristics were comparable. Clinical tumour stage (AJCCv8) was higher in the remote and rural group: stage 0: 2(1%) U, 1(2%) R; stage I: 38(17%) U, 7(11%) R; stage II: 49(22%) U, 5(9%) R; stage III: 58(26%) U, 27(47%) R; stage IV: 65(29%) U, 12(21%) R; p=0.01. The number of curative resections (U: 134(59%), R: 37(65%)), palliative surgeries (U: 45(20%), R: 12(21%)) and rate of non-resection (U: 47(21%), R: 8(14%)) were comparable (p=0.51). Use of laparoscopic surgical approach (U: 59(26%); R: 14(25%); p=0.13), operative time (U: 162 minutes [137-187], R: 164 minutes [150-192]; p=0.34), estimated blood loss (U: 200 mL [100-400], R: 350 mL [113-675]; p=0.12), length of stay (U: 6 days [4-10], R: 6 days [5-8]; p=0.54) and incidence of major complications (Clavien-Dindo≥3) within 30 days of surgery (U: 43(19%), R: 8(14%); p=0.55) did not differ between groups. Five-year OS was similar regardless of geographical distribution (U: 0.45 [0.39-0.52], R: 0.61 [0.48-0.74]; p=0.10) (Figure 1).
Conclusion
Residing in a rural or remote area had a negative impact on disease stage at presentation for patients with newly diagnosed gastric cancer. However, in the context of an established care corridor to a specialized cancer centre, treatment patterns and overall survival were comparable to those living in urbanized areas.
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