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Impact of Rurality on Stage IV Ovarian Cancer at Diagnosis: A Midwest Cancer Registry Cohort Study
Author(s) -
Weeks Kristin S.,
Lynch Charles F.,
West Michele,
McDonald Megan,
Carnahan Ryan,
Stewart Sherri L.,
Charlton Mary
Publication year - 2020
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/jrh.12419
Subject(s) - rurality , medicine , cancer registry , cohort , ovarian cancer , cancer , cohort study , stage (stratigraphy) , oncology , gynecology , family medicine , gerontology , rural area , pathology , biology , paleontology
Purpose We aim to understand if rurality impacts patients’ odds of presenting with stage IV ovarian cancer at diagnosis independent of distance to primary care provider and the socioeconomic status of a patient's residential census tract. Methods A cohort of 1,000 women with ovarian cancer in Iowa, Kansas, and Missouri were sampled and analyzed from the cancer registries’ statewide population data. The sample contained those with a histologically confirmed primary ovarian cancer diagnosis in 2011‐2012. All variables were captured through an extension of standard registry protocol using standardized definitions and abstraction manuals. Chi‐square tests and a multivariable logistic regression model were used. Findings At diagnosis, 111 women in our sample had stage IV cancer and 889 had stage I‐III. Compared to patients with stage I‐III cancer, patients with stage IV disease had a higher average age, more comorbidities, and were more often living in rural areas. Multivariate analysis showed that rural women (vs metropolitan) had a greater odds of having stage IV ovarian cancer at diagnosis (odds ratio = 2.41 and 95% confidence interval = 1.33‐4.39). Conclusion Rural ovarian cancer patients have greater odds of having stage IV cancer at diagnosis in Midwestern states independent of the distance they lived from their primary care physician and the socioeconomic status of their residential census tract. Rural women's greater odds of stage IV cancer at diagnosis could affect treatment options and mortality. Further investigation is needed into reasons for these findings.