Examining Urban and Rural Differences in How Distance to Care Influences the Initiation and Completion of Treatment among Insured Cervical Cancer Patients

Cancer Epidemiol Biomarkers Prev. 2019 May;28(5):882-889. doi: 10.1158/1055-9965.EPI-18-0945. Epub 2019 Feb 7.


Background: Although rural cancer patients encounter substantial barriers to care, they more often report receiving timely care than urban patients. We examined whether geographic distance, a contributor to urban-rural health disparities, differentially influences treatment initiation and completion among insured urban and rural cervical cancer patients.

Methods: We identified women diagnosed with cervical cancer from 2004 to 2013 from a statewide cancer registry linked to multipayer, insurance claims. Primary outcomes were initiation of guideline-concordant care within 6 weeks of diagnosis and, among stage IB2-IVA cancer patients, completion of concurrent chemoradiotherapy (CCRT) in 56 days. We estimated risk ratios using modified Poisson regressions, stratified by urban/rural status, to examine the association between distance and treatment timing (initiation or completion).

Results: Among 999 stage IA-IVA patients, 48% initiated guideline-concordant care within 6 weeks of diagnosis, and 37% of 492 stage IB2-IVA cancer patients completed CCRT in 56 days. In urban areas, stage IA-IVA patients who lived ≥15 miles from the nearest treatment facility were less likely to initiate timely treatment compared with those <5 miles [risk ratio (RR): 0.72; 95% confidence intervals (CI), 0.54-0.95]. Among IB2-IVA stage cancer patients, rural women residing ≥15 miles from the nearest radiation facility were more likely to complete CCRT in 56 days (RR: 2.49; 95% CI, 1.12-5.51).

Conclusions: Geographic distance differentially influences the initiation and completion of treatment among urban and rural cervical cancer patients.

Impact: Distance was an access barrier for insured cervical cancer patients in urban areas whereas rural patients may require more intensive outreach, support, and resources, even among those living closer to treatment.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Chemoradiotherapy / statistics & numerical data
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance Benefits / statistics & numerical data
  • Middle Aged
  • North Carolina / epidemiology
  • Registries
  • Retrospective Studies
  • Rural Population / statistics & numerical data
  • Urban Population / statistics & numerical data
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / therapy*