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J Rural Health. 2019 Feb 19. doi: 10.1111/jrh.12355. [Epub ahead of print]

Association Between Rurality and Lung Cancer Treatment Characteristics and Timeliness.

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Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine.
Department of Medicine, Maine Medical Center, Portland, Maine.
Muskie School of Public Service, University of Southern Maine, Portland, Maine.



Lung cancer is the leading cause of cancer-related mortality in the United States, and rural states bear a greater burden of disease.


We analyzed tumor registry data to examine relationships between rurality and lung cancer stage at diagnosis and treatment. Cases were from the Maine Cancer Registry from 2012 to 2015, and rurality was defined using rural-urban commuting areas. Multivariable models were used to examine the relationships between rurality and treatment, adjusting for age, sex, poverty, education, insurance status, and cancer stage.


We identified 5,338 adults with incident lung cancer; 3,429 (64.2%) were diagnosed at a late stage (III or IV). Rurality was not associated with stage at diagnosis. For patients with early-stage disease (I or II), rurality was not associated with receipt of treatment. However, for patients with late-stage disease, residents of large rural areas received more surgery (10%) compared with metropolitan (9%) or small/isolated rural areas (6%), P = .01. In multivariable analyses, patients in large rural areas received more chemotherapy (OR 1.48; 95% CI: 1.08-2.02) than those in metropolitan areas. Patients with early-stage disease residing in small/ isolated rural areas had delays in treatment (median time to first treatment = 43 days, interquartile range [IQR] 22-68) compared with large rural (34 days, IQR 17-55) and metropolitan areas (35 days, IQR 17-60), P = .0009.


Rurality is associated with differences in receipt of specific lung cancer treatments and in timeliness of treatment.


cancer; lung cancer; rurality; timeliness of treatment; treatment delay


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