Cancer Clinical Trials Resolve Disparities Between Urban and Rural Patients


Improved access to uniform cancer care in rural areas could help reduce disparities seen between rural and urban patients.

Despite known disparities in outcomes between patients with cancer who live in rural and urban areas, a new study found that participating in cancer clinical trials significantly reduced the differences in survival rates between the 2 groups.

The study, published in JAMA Network Open, compared the geographic distribution and survival outcomes for rural versus urban patients with cancer treated in clinical trials.

According to the CDC, 180 out of 100,000 patients died of cancer in rural areas compared with 158 out of 100,000 patients in urban areas between 2011 and 2015.

In the new study, researchers analyzed existing data from clinical trials conducted by SWOG, the international cancer clinical trials network funded by the National Cancer Institute. The researchers identified 36,995 patients who enrolled in 44 SWOG phase 2 or 3 treatment trials between 1986 and 2012, and limited their analysis of survival to the first 5 years after trial enrollment.

“The goal of this expansion was to provide access and test interventions to reduce disparities by improving the quality of care across the cancer continuum among rural populations,” Worta McCaskill-Stevens, MD, chief of the Community Oncology and Prevention Trials Research Group at NCI, said in the press release.

The study included patients from all 50 states with 17 different cancer types, including acute myeloid leukemia, sarcoma, lymphoma, myeloma, and brain, breast, colorectal, lung, ovarian, and prostate cancers.

Patients were categorized as either rural or urban based on US Department of Agriculture population classifications, known as Rural-Urban Continuum Codes. Patient outcomes included overall survival, progression-free survival, and cancer-specific survival.

Overall, the results showed no meaningful difference in survival patterns between rural and urban patients for almost all of the cancer types, with the exception being patients with estrogen receptor-negative, progesterone receptor-negative breast cancer. However, the researchers noted that rural cancer patients did not live as long as urban patients, which they attributed to factors such as timely access to follow-up chemotherapy after their first round of treatment.

The findings suggest that expanding access to quality care can make a significant difference in closing the survival rate gaps between rural and urban patients, according to the study authors.

“If people diagnosed with cancer, regardless of where they live, receive similar care and have similar outcomes, then a reasonable interference is that the best way to improve outcomes for rural patients is to improve their access to quality care,” Joseph Unger, PhD, a SWOG biostatistician and health services research at Fred Hutchinson Cancer Research Center, said in a press release.

Expanding clinical trials into community hospitals and clinics in rural areas could be a way of improving the quality of cancer care that these patients receive, Dr Unger added. Patients in clinical trials are assessed and treated uniformly, with strict guideline-driven protocol. Improving access to the kind of uniform treatment strategies used in clinical trials may help resolve the disparity in cancer outcomes, the researchers concluded.


Unger J, Moseley A, Symington B, et al. Geographic distribution and survival outcomes for rural patients with cancer treated in clinical trials. JAMA Network Open. 2018. Doi: 10.1001/jamanetworkopen.2018.1235

Access to Care May Reduce Cancer Disparities [news release]. SWOG’s website. Accessed August 17, 2018.

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