Victoria M. Petermann

Rural patients’ experiences with diagnosis and treatment of endometrial cancer

AbstractBackgroundRural endometrial cancer (EC) patients are less likely to receive lymph node evaluation, high‐quality surgical care, and adjuvant therapy compared to urban patients. Developing interventions to effectively address barriers to quality care requires understanding patient experiences across the cancer care continuum. Our objective was to understand the diagnostic and treatment experiences of rural EC patients.MethodsWe conducted semistructured interviews with 23 participants (22 patients, one caregiver) from rural counties in North Carolina. We developed a semistructured interview guide to examine the experiences of patients during diagnosis and treatment. Initial codes were derived from a multilevel conceptual framework of rural cancer control, and transcribed interviews were analyzed using thematic analysis.ResultsWe identified six themes reflecting determinants of diagnosis and seven themes for treatment of EC for rural patients. Provider knowledge of EC symptoms, patient symptom normalization, and fear were all discussed as major factors impacting delays in EC diagnosis. Participants noted that social networks influenced them to seek care for symptoms they did not otherwise see as concerning. During treatment, participants experienced financial burdens, and many reported significant challenges traveling to treatment. Social networks were critical for financial support and transportation to and from treatment. Personal health care experiences and community perceptions about rural cancer care also influenced decisions about where to seek gynecologic cancer treatment.ConclusionsThis study highlights the need to improve rural provider adherence to guidelines for EC detection, increase symptom knowledge among rural communities, and implement comprehensive assessments of unmet needs of rural patients during treatment.

The Role of Rurality, Travel Time, and Neighborhood Socioeconomics on Patterns of Adjuvant Therapy Receipt among Patients with Endometrial Cancer

Abstract Background: Rural patients with endometrial cancer are more likely to receive lower-quality treatment compared with their urban peers. We evaluated the role of contextual factors [rurality, distance to care, and community socioeconomics (SES)] on the receipt of adjuvant therapy (AT): vaginal brachytherapy (VBT), external beam radiation, and chemotherapy. Methods: We analyzed Surveillance Epidemiology and End Results–Medicare and included stages IB grade 3 and stages II to IV. We used county-level rural–urban continuum codes to define rurality, the Yost index to measure community SES, and measure of average driving time to gynecologic oncology care. Multivariable logistic regression was used to estimate adjusted ORs (aOR) and 95% confidence intervals (CI) evaluating AT receipt, adjusting for patient-level clinical and demographic characteristics. Results: A total of 7,572 individuals met inclusion criteria; 15% were rural residing. Rurality was only associated with lower odds of any AT receipt among patients with stage IB endometrial cancer (aOR = 0.62; 95% CI, 0.46–0.83). Increasing travel time was associated with lower odds of VBT (aOR = 0.89; 95% CI, 0.84–0.95). Residence in a low-SES neighborhood was associated with lower odds of chemotherapy (aOR = 0.79; 95% CI, 0.67–0.92) and VBT (aOR = 0.81; 95% CI, 0.69–0.95); however, associations were no longer significant after adjusting for individual SES. Conclusions: Travel time to gynecologic oncology care negatively affects the receipt of treatment regardless of rural or urban residence. Travel time may be a proxy for access to brachytherapy services and may explain the associations between travel and receipt of VBT. Impact: Factors characterizing the place of residence beyond rural/urban residence are important for predicting inequitable access to AT.