Association of rurality with guideline-concordant survivorship care receipt among Medicare beneficiaries with colorectal cancer.

Abstract

e23130 Background: Rural-urban disparities strongly impact colorectal cancer screening, diagnosis, and treatment, creating challenges that persist beyond initial treatment. Cancer survivorship care is crucial for the monitoring and management of adverse health outcomes that impact quality of life and healthcare costs. The extent of disparities in receipt of guideline-recommended survivorship care remains unclear. Identifying rural-urban disparities in guideline-recommended survivorship care is essential for advancing equitable cancer care. To address this gap, we investigated if rurality was associated with the receipt of timely, guideline-concordant survivorship care among Medicare beneficiaries. Methods: We used SEER-Medicare data from 2007-2014 to identify 4,785 Medicare beneficiaries who were diagnosed with colorectal cancer. We used data up to three years after surgical resection to evaluate receipt of survivorship care as recommended by the National Comprehensive Cancer Network. Guideline-concordant care was defined as receipt of recommended services and intervals for: colonoscopies, carcinoembryonic antigen tests, CT scans, and history & physical exams. Rurality was defined using Rural-Urban Commuting Area (RUCA) codes as: Urban, Suburban, Large Rural, Small Rural. We used a logistic regression model to evaluate the association between rurality and guideline-concordant care, adjusting for confounding variables. Analyses were stratified by survival time after surgery (0-2 and 2-3 years). Results: No significant differences were observed in the proportion of beneficiaries receiving guideline-concordant care by rurality. Of those surviving 0-2 years after surgery, those with regional cancers had greater odds of receiving guideline-concordant care compared to those with in situ cancers (odds ratio/OR: 2.35, 95%CI (1.29, 4.69)). Older age was also significantly associated with increasingly reduced odds of receiving guideline-concordant care (age 85+ OR: 0.35, 95% CI (0.27, 0.46) compared to 65-74 years). Non-dual eligible beneficiaries had 64% greater odds of receiving guideline-concordant care compared to dual eligible beneficiaries (OR: 1.64, 95% CI (1.32, 2.04)). Of those surviving 2-3 years post-surgery, those age 85+ years had 85% reduced odds of receiving guideline-concordant care compared to those 65-74 years old. No association was found between rurality and receipt of guideline-concordant care. Conclusions: We observed no significant association between rurality and receipt of guideline-concordant survivorship care. Sex, cancer stage, age, and person-level socioeconomic status were found to be significant predictors of receipt for guideline-concordant survivorship care. Future research should focus on potential drivers of disparities in these areas for colorectal cancer survivors.