ArticleGynecologic oncology2019
Evaluating the urban-rural paradox: The complicated relationship between distance and the receipt of guideline-concordant care among cervical cancer patients.
Article in Gynecologic oncology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed, 57 citations in OpenAlex.
- Exploring Racial Disparities in Awareness and Perceptions of Oncology Clinical Trials: Cross-Sectional Analysis of Baseline Data From the mychoice Study.JMIR cancer · 2024Trial
- Female genital schistosomiasis, human papilloma virus infection, and cervical cancer in rural Madagascar: a cross sectional study.Infectious diseases of poverty · 2023Trial
- Treatment patterns and survival outcomes in neuroendocrine neoplasms presenting with brain metastases.Journal of neuro-oncology · 2026Article
- Surgically Treated Cervical Cancer in Manitoba: A Retrospective Study of the Impact of Geography on Care.Current oncology (Toronto, Ont.) · 2026Article
- Article
- The Role of Rurality, Travel Time, and Neighborhood Socioeconomics on Patterns of Adjuvant Therapy Receipt among Patients with Endometrial Cancer.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025Article
- Inequities by race and ethnicity in cancer treatment receipt among people living with HIV and cancer in the U.S. (2004-2020).BMC cancer · 2025Article
- The Impact of Split Radiation Therapy on the Management of Locally Advanced Cervical Cancer in Central Virginia.Cureus · 2025Article
- Financial toxicity in patients with glioblastoma.Journal of neuro-oncology · 2025Article
- A latent class assessment of healthcare access factors and disparities in breast cancer care timeliness.PLoS medicine · 2024Article
- Catchment area and cancer population health research through a novel population-based statewide database: a scoping review.JNCI cancer spectrum · 2024Article
- Receipt of Guideline-Concordant Care Is Associated With Improved Survival in Patients With Osteosarcoma in California: A Population-Based Analysis.JCO oncology practice · 2024Article
- Estimating the Impact of Rurality in Disparities in Cancer Mortality.JCO oncology practice · 2024Article
- Hospital Designations and Their Impact on Guideline-Concordant Care and Survival in Pancreatic Cancer. Do They Matter?Annals of surgical oncology · 2023Article
- The Relation Between Travel Distance and Overall Survival for HPV-Associated Cancers in a High-Burden State.Journal of registry management · 2023Article
- Rural-Urban Disparities in Cancer Outcomes: Opportunities for Future Research.Journal of the National Cancer Institute · 2022Review
- Treatment of cervical cancer: overcoming challenges in access to brachytherapy.Expert review of anticancer therapy · 2022Review
- Perspectives of cancer prevention and control resources from stakeholders in rural southern Illinois.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2022Article
- The impact of patient travel time on disparities in treatment for early stage lung cancer in California.PloS one · 2022Article
- Article
Corrections and comments
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
objectiveUrban-rural health disparities are often attributed to the longer distances rural patients travel to receive care. However, a recent study suggests that distance to care may affect urban and rural cancer patients differentially. We examined whether this urban-rural paradox exists among patients with cervical cancer.
methodsWe identified individuals diagnosed with cervical cancer from 2004 to 2013 using a statewide cancer registry linked to multi-payer, insurance claims. Our primary outcome was receipt of guideline-concordant care: surgery for stages IA1-IB1; external beam radiation therapy (EBRT), concomitant chemotherapy, and brachytherapy for stages IB2-IVA. We estimated risk ratios (RR) using modified Poisson regressions, stratified by urban/rural location, to examine the association between distance to nearest facility and receipt of treatment.
results62% of 999 cervical cancer patients received guideline-concordant care. The association between distance and receipt of care differed by type of treatment. In urban areas, cancer patients who lived ≥15 miles from the nearest surgical facility were less likely to receive primary surgical management compared to those <5 miles from the nearest surgical facility (RR: 0.77, 95% CI: 0.60-0.98). In rural areas, patients living ≥15 miles from the nearest brachytherapy facility were more likely to receive treatment compared to those <5 miles from the nearest brachytherapy facility (RR: 1.71, 95% CI: 1.14-2.58). Distance was not associated with the receipt of chemotherapy or EBRT.
conclusionsAmong cervical cancer patients, there is evidence supporting the urban-rural paradox, i.e., geographic distance to cancer care facilities is not consistently associated with treatment receipt in expected or consistent ways. Healthcare systems must consider the diverse and differential barriers encountered by urban and rural residents to improve access to high quality cancer care.
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