University of Utah School of Medicine Salt Lake City, UT
M. A. Atobiloye1, C. Dechet2, S. B. Johnson3, B. Odei3, J. D. Tward3, and G. Suneja3,4; 1University of Utah School of Medicine, SALT LAKE CITY, UT, 2Univeristy of Utah Huntsman Cancer Institute, SALT LAKE CITY, UT, 3Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 4Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
Purpose/Objective(s):Significant disparities exist in access to cancer treatment and cancer outcomes for rural populations, however less is known about differences in the cancer treatment experience. We aimed to examine patient-reported outcomes for people diagnosed with prostate cancer living in rural and non-rural communities in the Intermountain West region of the U.S. Materials/
Methods: Using an institutional database, we identified adults diagnosed with localized prostate cancer who received treatment at the Huntsman Cancer Institute. All patients were administered the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) at 3-6 month intervals for up to 5 years after biopsy to assess health and well-being related to their treatment. We used the USDA rural-urban commuting area codes (RUCA) to define rural (codes 7-10) and non-rural (codes 1-6). Nonparametric regression methods were used to model the differences in patients’ scores for these quality-of-life parameters: urinary irritative/obstructive symptoms (UIOS), urinary incontinence symptoms (UISS), bowel symptoms (BSS), sexual symptoms (SSS), and vitality & hormonal symptoms (VHSS). Finally, we compared progression and metastasis rates for both groups. The risk of progression and metastasis accounting for NCCN risk group was determined using cumulative incidence functions with death as a competing risk. Results: The cohort included 391 rural and 2,631 non-rural patients. There were no significant differences between the groups in age, cancer stage, NCCN risk group, or Charlson comorbidity score. In each 3-month time period, there was no difference between rural and non-rural patients for UIOS (p=0.61), UISS (p=0.34), BSS (p=0.11), or VHSS (p=0.85). Rural patients had significantly worse SSS (p<0.01). The global quality of life score was not significantly different between groups (p=0.59). Rural patients were more likely to develop metastasis after diagnosis than non-rural patients (HR 1.55, p=0.04), however the rate of treatment rendered at progression was not significantly different between the two groups (HR 1.16, p=0.34). Conclusion: Among prostate cancer patients treated in the Intermountain West, there is evidence that rural geographical location is associated with elevated sexual dysfunction following treatment and an increased risk of metastasis. Despite this increased risk, there was no difference in therapy rendered at progression. Other patient-reported outcome scores did not differ, which may reflect the efforts of providers and health systems to engage patients from rural environments or could represent selection bias in the rural patients that received treatment at our institution’s center vs. those that were lost to follow-up or were treated locally.
