eP719 - Geographic Differences in Colorectal Cancer Care: Insight from a Statewide Cancer Registry

Author(s)

• 

  Meghan E. Lark, MD (she/her/hers)

  General Surgery Resident
  Indiana University School of Medicine
  Indiana University School of Medicine
  Indianapolis, IN, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

ePoster Presenter(s)

• 

  Kristen N. Kaiser, MD (she/her/hers)

  General Surgery Resident
  Indiana University School of Medicine
  Indiana University
  Indianapolis, IN, United States

  Disclosure information not submitted.

Author(s)

• SM

  Sean McGuire, MD (he/him/his)

  General Surgery Resident
  Indiana University School of Medicine
  Indiana University
  Indianapolis, IN, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• HA

  Hannah Allison, MA

  Project Management Specialist
  Indiana University School of Medicine
  Indianapolis, Indiana, United States

  Disclosure information not submitted.
• TR

  Tyler Robinson, MD

  General Surgery Resident
  Indiana University
  Indianapolis, Indiana, United States

  Disclosure information not submitted.
• CF

  Cyrus Feizpour, MD

  General Surgery Resident
  Indiana University School of Medicine
  Indianapolis, Indiana, United States

  Disclosure information not submitted.
• PJ

  Peter Jenkins, MD, MSc

  Associate Professor
  Indiana University School of Medicine, Department of Surgery
  Indianapolis, Indiana, United States

  Disclosure information not submitted.
• BR

  Bruce Robb, MD

  Associate Professor of Clinical Surgery
  Indiana University School of Medicine
  Indianapolis, Indiana, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Sanjay Mohanty, MD (he/him/his)

  Assistant Professor of Surgery
  Indiana University School of Medicine
  Indiana University School of Medicine
  Indianapolis, IN, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: Colorectal cancer (CRC) incidence and mortality rates have decreased consistently over time, however significant disparities persist based on race, socioeconomic status, and geographic location. In the state of Indiana, 48 out of 92 total counties are considered rural and are home to nearly one-fifth of the state population. Understanding the impact of rural-urban disparities on CRC is vital for ensuring equitable access to care in our state. Our study uses a population-based database to compare patients with CRC across geographic strata, and evaluate the influence of geography on CRC management, recurrence, and survival.Methods/Interventions: We used a population-based, statewide cancer registry that captured all gastrointestinal malignancies from 2000-2020. Our cohort was stratified by anatomical site, including colon, appendiceal, rectal, and anal. Patient demographics such as age, sex, race, location, and payor status were described. Geographic strata were defined based on the United States Department of Agriculture Rural-Urban Continuum Codes (RUCC), and our cohort was divided into two groups: metropolitan and non-metropolitan. CRC characteristics, type of therapy, and survival rates were compared between geographic strata. Additionally, we examined patient population trends in non-metropolitan areas over time.Results/Outcomes: Of 76,271 patients with CRC, the majority (74%) had colon cancers and the median age was 69 years old. Fifty percent of patients were male, 91% were White, and 73% lived in metropolitan areas. Medicare/Medicaid was the most common payor status (58%), followed by private insurance (21%). Metropolitan patients were more likely to be younger (68 vs. 70 years), have private insurance (22% vs. 17%), and have localized or in situ disease at diagnosis (43% vs. 41%) (p < 0.001). When stratified by age, CRC patients < 50 years old were more likely to live in metropolitan areas than patients >50 years (12% vs. 10%, p < 0.001). Furthermore, Black patients were significantly more likely to reside in metropolitan areas (10% vs. 1.3%, p < 0.001). Non-metropolitan patients were more likely to undergo chemotherapy (27% vs. 25%), radiation (16% vs.14%), and surgical treatment (81% vs. 79%) (p < 0.001). Recurrence was significantly higher in patients from non-metropolitan areas (23% vs. 14%, p < 0.001), however no survival differences were demonstrated between the two groups. Additionally, the overall number of patients living in a non-metropolitan area downtrended throughout the study period (Figure 1)Conclusion/

Discussion: We observed significant geographical differences in patient demographics, clinical presentation, and disease recurrence in our statewide cohort of CRC patients. Future work will focus on oncologic care processes (e.g., margin status, nodal harvest) and the intersection of race, socioeconomic status, and geography, with the overall goal of identifying and developing system-level interventions to address care disparities.Figure 1Percent of colorectal cancer patients who resided outside of metropolitan areas over time