Access to Cancer Services for Rural Colorectal Cancer Patients


  • This research was supported by grant R01CA089544 from the National Cancer Institute, National Institutes of Health, and by the WWAMI Rural Health Research Center, which is funded by the Health Resources and Services Administration's federal Office of Rural Health Policy. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Cancer Institute or the Office of Rural Health Policy. This work was begun when Dr. Cai and Dr. Larson were research scientists in the University of Washington's Department of Family Medicine. For further information, contact: Laura-Mae Baldwin, MD, MPH, University of Washington, Department of Family Medicine, Box 354982, Seattle, WA 98195-4982; e-mail


ABSTRACT: Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services—surgery, medical oncology consultation, and radiation oncology consultation. Methods: Descriptive cross-sectional study using linked Surveillance, Epidemiology, and End Results (SEER) cancer registry and Medicare claims data for 27,143 individuals ages 66 and older diagnosed with stages I through III CRC between 1992 and 1996. Findings: Over 90% of rural CRC patients lived within 30 miles of a surgical hospital offering CRC surgery, but less than 50% of CRC patients living in small and isolated small rural areas had a medical or radiation oncologist within 30 miles. Rural CRC patients who traveled outside their geographic areas for their cancer care often went great distances. The median distance traveled by rural cancer patients who traveled to urban cancer care providers was 47.8 miles or more. A substantial proportion (between 19.4% and 26.0%) of all rural patients bypassed their closest medical and radiation oncology services by at least 30 miles. Conclusions: Rural CRC patients often travel long distances for their CRC care, with potential associated burdens of time, cost, and discomfort. Better understanding of whether this travel investment is paid off in improved quality of care would help rural cancer patients, most of whom are elderly, make informed decisions about how to use their resources during their cancer treatment.