ArticleCancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology2025
The Role of Rurality, Travel Time, and Neighborhood Socioeconomics on Patterns of Adjuvant Therapy Receipt among Patients with Endometrial Cancer.
Article in Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- The rural-urban paradox: rethinking delays in breast cancer care.Gland surgery · 2026Article
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Abstract
backgroundRural patients with endometrial cancer are more likely to receive lower-quality treatment compared with their urban peers. We evaluated the role of contextual factors [rurality, distance to care, and community socioeconomics (SES)] on the receipt of adjuvant therapy (AT): vaginal brachytherapy (VBT), external beam radiation, and chemotherapy.
methodsWe analyzed Surveillance Epidemiology and End Results-Medicare and included stages IB grade 3 and stages II to IV. We used county-level rural-urban continuum codes to define rurality, the Yost index to measure community SES, and measure of average driving time to gynecologic oncology care. Multivariable logistic regression was used to estimate adjusted ORs (aOR) and 95% confidence intervals (CI) evaluating AT receipt, adjusting for patient-level clinical and demographic characteristics.
resultsA total of 7,572 individuals met inclusion criteria; 15% were rural residing. Rurality was only associated with lower odds of any AT receipt among patients with stage IB endometrial cancer (aOR = 0.62; 95% CI, 0.46-0.83). Increasing travel time was associated with lower odds of VBT (aOR = 0.89; 95% CI, 0.84-0.95). Residence in a low-SES neighborhood was associated with lower odds of chemotherapy (aOR = 0.79; 95% CI, 0.67-0.92) and VBT (aOR = 0.81; 95% CI, 0.69-0.95); however, associations were no longer significant after adjusting for individual SES.
conclusionsTravel time to gynecologic oncology care negatively affects the receipt of treatment regardless of rural or urban residence. Travel time may be a proxy for access to brachytherapy services and may explain the associations between travel and receipt of VBT. IMPACT: Factors characterizing the place of residence beyond rural/urban residence are important for predicting inequitable access to AT.
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