Kriyana P Reddy, Cara L Berkowitz, Kathleen Jarrell, Rachel Berger, Sarah Hulse, Leisha C Elmore, Rebecca Fishman, Alina M Mateo, Dahlia M Sataloff, Julia C Tchou, Jennifer Q Zhang, Anne Marie McCarthy, Oluwadamilola M Fayanju
{"title":"The Effect of Rurality on Time to Surgery and Overall Survival among Women with Breast Cancer.","authors":"Kriyana P Reddy, Cara L Berkowitz, Kathleen Jarrell, Rachel Berger, Sarah Hulse, Leisha C Elmore, Rebecca Fishman, Alina M Mateo, Dahlia M Sataloff, Julia C Tchou, Jennifer Q Zhang, Anne Marie McCarthy, Oluwadamilola M Fayanju","doi":"10.1097/SLA.0000000000006710","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>How does distance to care affect time to surgery (TTS) and overall survival (OS) among rural patients with breast cancer?</p><p><strong>Summary background data: </strong>TTS>60 days is associated with known sociodemographic characteristics and worse OS after breast cancer diagnosis, but the relationship between rurality, proximity to care, TTS, and OS remains unknown.</p><p><strong>Methods: </strong>We identified females≥18 years with stage 0-III breast cancer diagnosed 2004-2019 who received upfront surgery in the National Cancer Database. Mediation and Cox proportional hazards analyses were conducted to assess the relationship between rurality, distance to treatment facility, prolonged TTS (i.e., >60 days), and OS.</p><p><strong>Results: </strong>Of 1,979,194 patients meeting inclusion criteria, 1.4% resided in rural areas. In the multivariate mediation analysis, the total effect of rurality on prolonged TTS corresponded to an aOR of 0.89 (95% CI 0.86-0.93), the direct effect corresponded to an aOR of 0.84 (95% CI 0.79-0.89), and the indirect effect corresponded to an aOR of 1.10 (95% CI 1.09-1.10). Over 50% of the total effect of rurality on prolonged TTS was mediated by proximity to treatment facility. After adjusting for clinical and sociodemographic factors, TTS of 61-90 days was associated with worse OS in both rural (HR 1.37, 95% CI 1.14-1.63) and urban (HR 1.75, 95% CI 1.72-1.78) patients with comparable results observed for TTS >90 days.</p><p><strong>Conclusions: </strong>Although geographic proximity to care mediates the relationship between rurality and prolonged TTS, rurality has an intrinsic protective effect on TTS that is independent of the adverse effect of increased distance to care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5000,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006710","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: How does distance to care affect time to surgery (TTS) and overall survival (OS) among rural patients with breast cancer?
Summary background data: TTS>60 days is associated with known sociodemographic characteristics and worse OS after breast cancer diagnosis, but the relationship between rurality, proximity to care, TTS, and OS remains unknown.
Methods: We identified females≥18 years with stage 0-III breast cancer diagnosed 2004-2019 who received upfront surgery in the National Cancer Database. Mediation and Cox proportional hazards analyses were conducted to assess the relationship between rurality, distance to treatment facility, prolonged TTS (i.e., >60 days), and OS.
Results: Of 1,979,194 patients meeting inclusion criteria, 1.4% resided in rural areas. In the multivariate mediation analysis, the total effect of rurality on prolonged TTS corresponded to an aOR of 0.89 (95% CI 0.86-0.93), the direct effect corresponded to an aOR of 0.84 (95% CI 0.79-0.89), and the indirect effect corresponded to an aOR of 1.10 (95% CI 1.09-1.10). Over 50% of the total effect of rurality on prolonged TTS was mediated by proximity to treatment facility. After adjusting for clinical and sociodemographic factors, TTS of 61-90 days was associated with worse OS in both rural (HR 1.37, 95% CI 1.14-1.63) and urban (HR 1.75, 95% CI 1.72-1.78) patients with comparable results observed for TTS >90 days.
Conclusions: Although geographic proximity to care mediates the relationship between rurality and prolonged TTS, rurality has an intrinsic protective effect on TTS that is independent of the adverse effect of increased distance to care.
期刊介绍：
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
