Compared to the urban population, patients in rural areas face healthcare disparities and experience inferior healthcare-related outcomes. To compare the healthcare quality metrics and outcomes between patients with advanced genitourinary cancers from rural versus urban areas treated at a tertiary cancer hospital, in this retrospective study, eligible patients with advanced genitourinary cancers were treated at Huntsman Cancer Institute, an NCI-Designated Comprehensive Cancer Center in Utah. Rural–urban commuting area codes were used to classify the patients’ residences as being in urban (1–3) or rural (4–10) areas. The straight line distances of the patients’ residences from the cancer center were also calculated and included in the analysis. The median household income data were obtained and calculated from “The Michigan Population Studies Center”, based on individual zip codes. In this study, 2312 patients were screened, and 1025 eligible patients were included for further analysis (metastatic prostate cancer (n= 679), metastatic bladder cancer (n= 184), and metastatic renal cell carcinoma (n= 162). Most patients (83.9%) came from urban areas, while the remainder were from rural areas. Both groups had comparable demographic profiles and tumor characteristics at baseline. The annual median household income of urban patients was $8604 higher than that of rural patients (p< 0.001). There were fewer urban patients with Medicare (44.9% vs. 50.9%) and more urban patients with private insurance (40.4% vs. 35.1%). There was no difference between the urban and rural patients regarding receiving systemic therapies, enrollment in clinical trials, or tumor genomic profiling. The overall survival rate was not significantly different between the two populations in metastatic prostate, bladder, and kidney cancer, respectively. As available in a tertiary cancer hospital, access to care can mitigate the difference in the quality of healthcare and clinical outcomes in urban versus rural patients.
与城市人口相比，农村地区患者面临医疗资源差异，其医疗相关结局也相对较差。为比较在三级癌症医院接受治疗的晚期泌尿生殖系统癌症患者中，农村与城市患者在医疗质量指标及临床结局方面的差异，本研究回顾性分析了在犹他州国家癌症研究所指定的综合性癌症中心——亨茨曼癌症研究所接受治疗的符合条件的晚期泌尿生殖系统癌症患者。研究采用城乡通勤区域代码将患者居住地划分为城市（1-3级）或农村（4-10级）区域，同时计算了患者居住地与癌症中心的直线距离并纳入分析。家庭收入中位数数据基于个人邮政编码从“密歇根人口研究中心”获取并计算。本研究共筛查2312例患者，最终纳入1025例符合条件者进行深入分析，包括转移性前列腺癌（679例）、转移性膀胱癌（184例）和转移性肾细胞癌（162例）。大多数患者（83.9%）来自城市地区，其余来自农村地区。两组患者在基线时的人口学特征和肿瘤特征具有可比性。城市患者的家庭年收入中位数比农村患者高8604美元（p<0.001）。城市患者中参加医疗保险者比例较低（44.9%对50.9%），而拥有私人保险者比例较高（40.4%对35.1%）。在全身治疗接受率、临床试验参与率及肿瘤基因组分析方面，城乡患者间无显著差异。对于转移性前列腺癌、膀胱癌和肾癌患者，两组人群的总生存率均未呈现显著差异。研究表明，在三级癌症医院可及的医疗条件下，获得医疗照护的机会能够缓解城乡患者在医疗质量与临床结局方面的差异。
肿瘤(癌症)患者之家