Perioperative Outcomes of Rural-Dwelling Patients Undergoing Lung and Colon Cancer Operation in Rural Facility

BACKGROUND: Cancer patients in rural areas often encounter significant barriers to accessing cancer care. This study evaluated whether Medicare-aged patients can safely undergo lung and colon cancer surgery at their local rural hospital, limiting travel burden. STUDY DESIGN: The SEER-Medicare files were used to identify patients with stage I-III colon and lung cancers. Patients residing in ZIP codes outside a metropolitan statistical area (MSA) were defined as rural; facilities were categorized similarly. Rural patients undergoing elective colon or lung cancer surgery at rural vs urban facilities were compared. Unadjusted and risk-adjusted complication and mortality rates were compared using multivariate logistic regression. Driving distances between patients’ residences and surgery facilities were calculated based on ZIP codes. RESULTS: A total of 10,383 rural colon cancer patients and 6,006 rural lung cancer patients were identified. There were no clinically significant differences between rural and urban treatment in either colon or lung cohorts in terms of demographics or cancer stage; their comorbidity risks were similar. Mortality and complication rates were comparable across urban and rural facilities. Travel distance was significantly greater for patients treated at urban facilities compared with rural for both colon (49 vs 16 miles, p<0.001) and lung (61 vs 35 miles, p<0.001) patients. CONCLUSIONS: Rural patients can achieve comparable short term surgical outcomes for lung and colon cancer when treated at local rural facilities, decreasing the travel burden of treatment at higher volume urban facilities.