HSR21-042: Disparities in Care Among Adolescent and Young Adult Cancer Patients Based on Residential Metro Versus Non-Metro Categorization and Distance From Cancer Treatment Site

Authors: Apoorva Anandan MD1 and Amanda Parkes MD1,2
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  • 1 University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
  • | 2 University of Wisconsin Carbone Cancer Center, Madison, WI

Background: Given variable developmental maturity, adolescent and young adult (AYA) cancer patients have unique and largely unmet psychosocial needs. While prior studies have shown an increased mortality risk in rural AYAs, the scope of research pertaining to disparities in AYA care based on residence remains limited. We sought to evaluate receipt of supportive care services in AYA cancer patients treated at the University of Wisconsin Carbone Cancer Center (UWCCC), considering both metro versus non-metro residence as well as distance to UWCCC. Methods: Electronic health record query identified adult AYA cancer patients 19-39 years with at least two visits at UWCCC from 3/30/2019-3/29/2020. Identified patients were sent an electronic survey to assess self-reported care and navigation preferences. Responses were categorized based on residential location, using both reported distance from UWCCC (0-20, 21-100, and 101+ miles from UWCCC) and metro versus non-metro classification based on 2013 Rural-Urban Continuum Codes (RUCC) using 1-3 for metro and 4-9 for non-metro residence. Results: Survey results were obtained for 192 AYA patients, including 145 with RUCC categorization and 149 with distance to UWCCC. Survey responses categorized by residential metro versus non-metro categorization and distance to UWCCC are seen in Table 1. There was a trend towards increased receipt of supportive care services in patients from metro as compared with non-metro locations. Patients residing closer to UWCCC had a trend towards increased receipt of supportive care services. Additionally, patients living 0-20 miles from UWCCC were less likely to report location of services as a reason that they did not receive the supportive care services they needed or desired (8/60, 14%), which was statistically significant as compared with those living >100 miles from UWCCC (11/25, 44%, p=0.0037). Discussion: We identified trends to suggest that patient residence influences receipt of supportive care services, most notably in our study related to distance from cancer treatment site. Location of supportive care services was noted to be a hindrance to receipt of supportive care particularly for patients living >100 miles from UWCCC, but also for patients from non-metro residences. These findings suggest the need to identify methods to improve patient access to supportive care services, including consideration of novel telemedicine-based approaches to care for these vulnerable patients.

Table 1.

Survey Responses Regarding Supportive Care Services Categorized Based on Residential Metro Versus Non-Metro Categorization and Distance to UWCCC*.

Table 1.

Corresponding Author: Amanda Parkes, MD
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