Abstract PR10: Fewer rural cancer patients treated with antineoplastic agents
Authors: Bradley Cathy J. , Perraillon Marcelo Coca 
Published: August 2020

Abstract
Approximately one-fifth of the U.S. population lives in rural areas. Cancer in rural areas is characterized by late-stage diagnosis, care that is inconsistent with recommended guidelines, and higher mortality. To our knowledge, no research to date has examined the use of systemic agents in rural patients. We investigated whether rural patients are treated with newer, high-cost antineoplastic agents. We defined high-cost antineoplastic agents as those with costs above the median monthly cost in 2014 dollars, approximately $5,500 (https://www.mskcc.org/research-programs/health-policy-outcomes/cost-drugs). Most of these agents were approved in 2002 and later, while most lower-cost agents were approved prior to 2000. The most common high-cost agents identified in the study included oxaliplatin, bevacizumab, irinotecan, cetuximab, and panitumumab. Our study population comprised stage III and IV colorectal cancer patients identified in the 2011-2013 SEER-Medicare data. Rurality was defined as less urban and rural areas combined relative to large metropolitan areas. There were 4,383 patients who met our inclusion criteria. Of these, approximately 21% (N=901) lived in less urban and rural areas. Patients residing in rural areas were less likely to receive any antineoplastic treatment than their more urban counterparts (50% compared to 54%, p=0.01). Among those who received antineoplastic treatment, 71% of urban patients were prescribed newer, more costly agents relative to 68% of rural patients. Urban patients also had better survival, with a median survival time of 20 months compared to 16 months for rural patients (p&lt;0.05). In a multivariate logistic regression, we examined the receipt of any antineoplastic treatment and the receipt of high-cost agents, controlling for patient sex, race, stage, and rurality. When controlling for these factors, rural patients were significantly less likely to receive any antineoplastic treatment (odds ratio = 0.808, p&lt;0.01), although there was no significant difference in receipt of high-cost agents. Newer, high-cost antineoplastic agents are becoming the standard of care. Because peer exposure is associated with the likelihood of technology adoption, physicians in rural areas may not benefit from close peer relationships and thus may be reluctant to adopt new treatment approaches. Contextual factors such as poverty, social deprivation, health care resources, and distance traveled mediate outcomes in rural communities. In ongoing research, we are investigating the role each of these factors has in the use of new agents. Collectively understanding these determinants can shape policies and investments to reduce widening disparities.
This abstract is also being presented as Poster B077.
Citation Format: Cathy J. Bradley, Marcelo Coca Perraillon. Fewer rural cancer patients treated with antineoplastic agents [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR10.