Journal article
Care Patterns and Outcomes for Intrahepatic Cholangiocarcinoma by Rurality of Patient Residence in a Midwestern State
Journal of surgical oncology, Vol.131(3), pp.450-456
03/2025
DOI: 10.1002/jso.27939
PMCID: PMC11968445
PMID: 39364893
Appears in UI Libraries Support Open Access
Abstract
Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of the liver and has the worst prognosis of any tumor arising from the liver, with a 5-year survival as low as 10%. However, whether the rurality of a patient's residence impacts care received and survival has not been well studied. We aimed to assess differences in care patterns associated with the rurality of patient's residences and their impact on survival outcomes, hypothesizing that patients in rural areas would experience lower survival.BACKGROUNDIntrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of the liver and has the worst prognosis of any tumor arising from the liver, with a 5-year survival as low as 10%. However, whether the rurality of a patient's residence impacts care received and survival has not been well studied. We aimed to assess differences in care patterns associated with the rurality of patient's residences and their impact on survival outcomes, hypothesizing that patients in rural areas would experience lower survival.Adult patients diagnosed with ICC between 2010 and 2020 were identified in the Iowa Cancer Registry. Chi-square tests were used to compare values categorical variables by rural/urban status. Cox proportional hazards regression was used to determine associations with cancer-specific mortality.METHODSAdult patients diagnosed with ICC between 2010 and 2020 were identified in the Iowa Cancer Registry. Chi-square tests were used to compare values categorical variables by rural/urban status. Cox proportional hazards regression was used to determine associations with cancer-specific mortality.Of 672 patients diagnosed with ICC during the study period, 53%, 27%, and 21% resided in metropolitan, micropolitan, and rural areas, respectively. There were no significant differences in age, sex, stage at diagnosis, the proportion receiving chemotherapy within 12 weeks of diagnosis, and undergoing surgery across all groups. Additionally, the proportion receiving definitive care at a National Cancer Institute (NCI) designated center was comparable across the three groups (37% metro vs. 43% micro vs. 35% rural). However, rural residents had the highest proportion of traveling ≥ 50 miles for definitive care (22% metro vs. 41% micro vs. 56% rural). In multivariable analysis of patients with Stage 1-3 disease, younger age, receipt of chemotherapy, surgery, and definitive care at an NCI center were independently associated with decreased mortality risk. However, rural residence was not significantly associated with survival (HR: 0.64 [95% CI: 0.38-1.06]).RESULTSOf 672 patients diagnosed with ICC during the study period, 53%, 27%, and 21% resided in metropolitan, micropolitan, and rural areas, respectively. There were no significant differences in age, sex, stage at diagnosis, the proportion receiving chemotherapy within 12 weeks of diagnosis, and undergoing surgery across all groups. Additionally, the proportion receiving definitive care at a National Cancer Institute (NCI) designated center was comparable across the three groups (37% metro vs. 43% micro vs. 35% rural). However, rural residents had the highest proportion of traveling ≥ 50 miles for definitive care (22% metro vs. 41% micro vs. 56% rural). In multivariable analysis of patients with Stage 1-3 disease, younger age, receipt of chemotherapy, surgery, and definitive care at an NCI center were independently associated with decreased mortality risk. However, rural residence was not significantly associated with survival (HR: 0.64 [95% CI: 0.38-1.06]).Similar to other complex cancer diagnoses, we found that definitive care at an NCI center was associated with decreased mortality risk for patients with ICC. Although rural residence was not independently associated with survival in this cohort, rural residents traveled significantly longer distances to access definitive care. This highlights a crucial need to improve access to specialized centers for complex cancer care.CONCLUSIONSimilar to other complex cancer diagnoses, we found that definitive care at an NCI center was associated with decreased mortality risk for patients with ICC. Although rural residence was not independently associated with survival in this cohort, rural residents traveled significantly longer distances to access definitive care. This highlights a crucial need to improve access to specialized centers for complex cancer care.
Details
- Title: Subtitle
- Care Patterns and Outcomes for Intrahepatic Cholangiocarcinoma by Rurality of Patient Residence in a Midwestern State
- Creators
- Mohammed O Suraju - University of IowaDarren M Gordon - University of IowaAmanda R Kahl - University of IowaAna McCracken - University of Iowa Hospitals and ClinicsErica Maduokolam - University of Iowa Hospitals and ClinicsJordan GrimmettKomlan Guedeze - American University of AntiguaSarah Nash - University of IowaAziz Hassan - University of Iowa, Surgery
- Resource Type
- Journal article
- Publication Details
- Journal of surgical oncology, Vol.131(3), pp.450-456
- DOI
- 10.1002/jso.27939
- PMID
- 39364893
- PMCID
- PMC11968445
- NLM abbreviation
- J Surg Oncol
- ISSN
- 1096-9098
- eISSN
- 1096-9098
- Publisher
- Wiley; HOBOKEN
- Grant note
- This study was supported by the National Cancer Institute at the National Institute of Health (grant numbers HHSN261201800012I/HHSN26100001) and the University of Iowa Holden Comprehensive Cancer Center 3P30CA086862 (A.R.K. and S.N.).: HHSN261201800012I/HHSN26100001 National Cancer Institute at the National Institute of Health: 3P30CA086862
This study was supported by the National Cancer Institute at the National Institute of Health (grant numbers HHSN261201800012I/HHSN26100001) and the University of Iowa Holden Comprehensive Cancer Center 3P30CA086862 (A.R.K. and S.N.).
- Language
- English
- Electronic publication date
- 10/04/2024
- Date published
- 03/2025
- Academic Unit
- Epidemiology; Surgery; Center for Social Science Innovation; Community and Behavioral Health
- Record Identifier
- 9984721135402771
Metrics
11 Record Views