Impact of rurality on patients with synchronous colorectal cancers.

Abstract

e23297 Background: Nearly 20% of Americans reside in rural communities, defined by the U.S. Census as areas not included within urbanized regions or clusters. Rural communities face significant disparities in cancer care access due to geographic isolation, limited healthcare infrastructure, and provider shortages, often resulting in delayed diagnosis and treatment. Synchronous colorectal cancers (synCRC), defined as two or more separate primary CRCs that are diagnosed in the same individual within 6 months, account for less than 10% of CRCs. There is a poorer prognosis, higher risk of relapse, and lower overall survival with synCRC when compared to solitary CRC. The risk factors for most cases of synCRC are not known. To our knowledge, this is the first study to explore the association between synCRC and rurality in a West Virginia cancer population. Methods: Data were obtained from a retrospective chart review of West Virginia University Cancer Institute’s (WVUCI) synchronous cancers database, which contains clinical and demographic information on 285 patients diagnosed with synchronous cancers at the WVUCI between 2020 and 2023. Geographic information for each patient was geocoded and cross-referenced with the federal Rural-Urban Commuting Area (RUCA) code database such to assign each case a RUCA code between 1 (metropolitan) and 10 (rural) as a measure of the patient’s rurality. A binomial exact test with a type I error threshold of 0.05 was applied to compare the observed proportion of rural synCRC cases to the expected proportion based on West Virginia’s population distribution. Results: A total of 11 (3.9%) cases of synCRC were identified in the database. The median age was 71 years (range, 54-83). All patients were white and non-Hispanic and nine patients (81.8%) were male. Seven patients (63.6%) resided in rural areas with RUCA codes between 7-10. None of the patients had Lynch Syndrome-associated germline mutations in MLH1 , MSH2 , MS H6, or PMS2 genes. The median progression-free survival was 9.6 months (range, 0.67-57.1) and median overall survival was 23.8 months (range, 6.8-57.1). Among the observed sample of synCRC, 63.6% of the cases were designated as rural, while 17.6% of the overall West Virginia population is classified as rural ( P = 0.0002). Conclusions: A disproportionate number of synCRC cases were observed among rural residents compared to what would be expected given the population distribution in West Virginia. These findings suggest a potential association between rurality and the diagnosis of synCRC, though larger studies are needed. Our preliminary analysis underscores the importance of investigating contributing factors such as healthcare infrastructure deficiencies, disparities in diagnostic timing, and access to care.