For Young Adults with Cancer, Hospital Distance Is Associated with Stage at Diagnosis

A new study found that, for adolescents and young adults (AYAs) with cancer, geographic distance from the hospital where they were diagnosed is associated with increased risk of later diagnosis and survival. These findings were published in Cancer.

Geography and Cancer Risk

“A number of studies have indicated that place of residence can influence cancer survival; however, few studies have specifically focused on geographic factors and outcomes in adolescents and young adults with cancer,” said lead author Kimberly Johnson, PhD, associate professor at Washington University in St. Louis, via press release.

For this study, Dr. Johnson and colleagues used the National Cancer database to analyze diagnosis stage and survival data for 46,418 and 178,688 patients, respectively, diagnosed with cancer between 2010 and 2014. Patients were aged between 15 and 39 years at diagnosis. The team looked at residential data to determine if patients lived in metro, urban, or rural counties at diagnosis, and patients were separated by short (<12.5 miles), intermediate (12.5 – 50 miles), or long (>50 miles) distance from the hospital where they were diagnosed. Late-stage diagnosis was defined as stages III and IV, and stages I and II were considered early stage.

Geography was found to be significantly associated with stage at diagnosis. The data showed that patients living in rural areas were 1.16 times more likely to have a late-stage diagnosis compared to those living in urban areas (95% confidence interval [CI], 1.05–1.29). Residing a long distance from the hospital was associated with a 1.20 times greater risk of later diagnosis versus short distance (95% CI, 1.16–1.25).

Survival was also impacted by the patients’ residential area. Patients in rural counties had a 1.17 times greater risk of mortality due to cancer than patients living in metro counties (95% CI, 1.05–1.31). Long versus short distances to the reporting hospital were associated with a 1.30 times higher risk of death (95% CI, 1.25–1.36).

“Disease stage mediated 54% and 31% of the associations between metro, urban, or rural residence and residential distance categories and survival,” the authors added.

In conclusion, the authors wrote, “The findings indicate that AYAs living in rural versus metropolitan US counties and those living farther from the diagnosis reporting hospital are more likely to be diagnosed at a later cancer stage, when it is generally less treatable, and have lower survival compared with AYAs living in metropolitan counties.”

“Hopefully, this research will draw attention to geographic disparities in AYA cancer survival,” said Dr. Johnson. “It will be important to conduct further research to understand the mechanisms for these findings and to develop interventions to address these disparities.”