ASPO Abstracts
Sociodemographic and Clinical Factors Associated with Radiation Treatment Nonadherence Among Rural and Nonrural Cancer Patients
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
Purpose. Cancer treatment nonadherence is associated with higher rates of cancer recurrence and decreased survival. Cancer patients living in rural areas experience a 10% higher mortality rate compared with their nonrural counterparts; geographic differences in adherence may contribute to this increased mortality. The goal of this study was to determine sociodemographic and clinical factors associated with radiation treatment nonadherence among cancer patients living in rural and nonrural areas.Methods. We used cancer registry and hospital billing claims data to measure radiation treatment nonadherence defined as 2+ missed appointments. Geographic residence was defined by USDA 2013 Rural-Urban Continuum Codes. We stratified to examine the effect modification of geographic residence, and used multivariable logistic regression with age, race, sex, insurance, cancer type, clinical stage, and treatment modality as covariates.Results. We identified 1928 cancer patients that averaged 62 years old, were 56% female, 63% white, 53% treated with external beam radiation, and 15% rural. While the number of missed appointments did not differ between rural and nonrural patients, rural patients attended fewer total appointments (p=0.007) and missed a higher percentage of appointment (17% vs. 14%, p=0.04). For rural patients, the odds of nonadherence increased by 8% with each additional appointment (p<0.0001) and those without health insurance were 3 times more likely to be nonadherent than those with commercial insurance (p=0.01). For nonrural patients, the odds of nonadherence increased by 12% with each additional appointment (p<0.0001), those with Medicaid were twice as likely to be nonadherent as those with commercial insurance (p=0.03), and those with stage 4 disease were twice as likely to be nonadherent as those with stage 1 disease (p<0.0001).Conclusions. In a geographically and racially diverse population, treatment nonadherence is a significant issue with unique factors contributing in rural and nonrural populations. Patient support should be uniquely targeted for rural and nonrural patients without insurance or Medicaid and with advanced cancer stage, and more hypofractionated guideline-concordant treatment options should be considered for these populations.
Keywords: Treatment nonadherence, radiation therapy, geographic disparities, rural cancer care delivery