Referral of lung cancer patients to university hospital cancer centers. A population-based study in two rural states

To determine whether the referral of lung cancer patients to university cancer centers was related to nonclinical factors, the medical charts were reviewed for almost all lung cancer patients diagnosed during the period of 1973-1976 in New Hampshire and Vermont. Greater distance from a cancer center, lower functional status, and age over 75 years were all inversely related to the use of university cancer centers both for diagnosis and for referral for treatment. Tumor cell type, patient marital status, and private medical insurance coverage were not related to the likelihood of being diagnosed in or referred to a university cancer center. In rural areas distance from a specialized medical center may be the dominant factor in determining whether patients are referred, especially for a disease such as lung cancer in which referral does not offer substantial survival advantages.