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Cancer patients living in rural areas tend to receive surgical intervention less often than those in urban areas. This article examines the main reasons.

Although it is currently understood that cancer care, and especially surgery, is limited in rural areas, the exact reasons for rural populations not receiving surgery for non-small cell lung cancer (NSCLC) are not well understood. This article, published in the Journal of Surgical Research, analyzes the geographic disparity-related reasons for failure to receive guideline-indicated surgical treatments in patients with NSCLC. The study relied on the National Cancer Database to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018.

The study included data from 324,785 patients with clinical stage I-IIIA NSCLC, with 42,361 from rural areas. The reason for nonreceipt of surgery was evaluated, and adjusted odds were determined for four treatment recommendations: primary nonsurgical management, surgery being deemed contraindicated due to risk, surgery being recommended but not performed, and an overall failure to receive surgery. Patients were treated at 1,307 facilities, and 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas showed increased odds of being recommended primary nonsurgical management, surgery being contraindicated due to risk, surgery being recommended but not performed, and an overall failure to receive surgery. 

The authors conclude by noting that the observed deviation from evidence-based guidelines may increase the risk for adverse outcomes and negatively impact overall survival. Because this type of cancer is resectable, failure to undergo surgery has potentially significant outcomes in patients with NSCLC. Further research is needed to understand what possible interventions may help this population.

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Logan, C. D., Feinglass, J., Halverson, A. L., Durst, D., Lung, K., Kim, S., Bharat, A., Merkow, R. P., Bentrem, D. J., & Odell, D. D. (2023). Rural–Urban Disparities in Receipt of Surgery for Potentially Resectable Non–Small Cell Lung Cancer. Journal of Surgical Research, 283, 1053-1063. https://doi.org/https://doi.org/10.1016/j.jss.2022.10.097