||5R01CA248470-03 Interpret this number
||Disparities in Access to and Outcomes of Cancer Surgery for Rural Medicare Patients
Though cancer diagnosis and treatment remain national health priorities, recent gains in cancer care have not
been deployed to the benefit of U.S. populations equally, particularly for cancers for which surgery is a primary
component of treatment. Rural areas have higher rates of cancer mortality than their urban counterparts, and
cancers for which effective screening exists tend to be more prevalent in rural populations. Rural patients
undergo fewer cancer-directed surgeries for some cancers and have worse surgical outcomes than urban
patients. Surgical disparities could be exacerbated by the continued closure of rural hospitals, potentially
limiting access to cancer surgery and specialist care for rural patients. Since 2004, over 400 rural hospitals
have closed their doors, and another 430 hospitals are at high risk of closure. Though rural-urban disparities
may result directly from these closures and the ensuing lack of access to surgical care, they may also be a
consequence of a general lack of economic and social opportunities. In this proposed research, we will explore
disparities in access to, treatment for, and outcomes of cancer care using Medicare claims data. While
differences in rural-urban outcomes have been examined, the intersectionality of rurality with other
sociodemographic characteristics (including racial/ethnic disparities and income) has not been examined for
cancers for which surgery is a primary treatment. We will 1) describe this intersectionality in disparities in
surgical care for lung, pancreatic, colon, and rectal cancers, 2) estimate the impact of hospital closure on
disparities in access, treatment, and outcomes for patients with cancer, and 3) assess the potential effects of
policy solutions in maintaining access to care for rural patients, including telemedicine and Medicaid
expansion. This proposed work will give us an overarching view into the landscape, current challenges, and
potential solutions for rural surgical cancer care. This work will allow us to better understand disparities in care
for rural underserved populations, and how geography intersects with race, ethnicity, and socioeconomic
status to exacerbate differences in access, quality, and outcomes.
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