Geographic Distribution and Survival Outcomes for Rural Cancer Patients Treated in Clinical Trials.

6569 Background: Studies show that cancer patients from rural areas have worse cancer outcomes than their urban counterparts. But studies relying on cancer population data are unable to account for differences in access to care. In contrast, clinical trial patients receive protocol-directed care by design, so large clinical trial databases are ideal for examining the impact of residency on outcomes. Methods: We compared the geographic distribution and survival outcomes for rural versus urban cancer clinical trial patients. We examined 36,995 patients from all 50 states enrolled in 44 phase III or II-III SWOG treatment trials from 1986-2012, comprising 17 different cancer-specific analysis cohorts. We examined overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS) for patients by rural/urban status to determine if residency – based on Rural-Urban Continuum Codes (RUCCs) – was associated with outcome. We used multivariate Cox regression to estimate the association of residency and survival outcomes, controlling for major disease-specific prognostic factors and demographic variables and stratifying by study. Different definitions of rurality were examined. The distribution of rural vs. urban patients by geographic region was described. Results: Overall, 19% of patients were from rural locations, the same as the rate of rural individuals in the U.S. Rural patients were older (≥65 years, 31% vs. 27%, p < .01) and less likely to be African American (5% vs. 12%, p < .01), but were similar with respect to sex (40% each) and were well represented within major geographic regions. Clinical prognostic factors were very similar. In multivariable regression, rural patients with adjuvant-stage ER-/PR- breast cancer had worse OS (HR = 1.27, p = .008) and CSS (HR = 1.26, p = .02). No other statistically significant differences were found. Results were consistent regardless of the definition of rurality. Conclusions: Rural and urban patients with uniform access to cancer care through participation in a trial had similar outcomes. This finding suggests that improving access to uniform treatment strategies for cancer patients may help resolve the rural/urban disparity in cancer outcomes.