Signals of inequity in the care pathway: rural lab diagnosis, systemic therapy delays, and RAS mutation differences in metastatic colorectal cancer - Report - MDSpire
Advertisement
Signals of inequity in the care pathway: rural lab diagnosis, systemic therapy delays, and RAS mutation differences in metastatic colorectal cancer
Disparities in the Care Pathway for Metastatic Colorectal Cancer
Overview
This study evaluates disparities in the care pathway for metastatic colorectal cancer (mCRC) in Saskatchewan, highlighting significant delays in systemic therapy for rural patients. While overall survival rates are similar between rural and urban patients, the findings indicate that rural diagnostic laboratory locations contribute to treatment delays.
Background
Colorectal cancer (CRC) is a leading cause of cancer-related mortality in Canada, with geographic disparities affecting patient outcomes. Timely biomarker testing is crucial for treatment selection in mCRC, yet access to these services may vary significantly between rural and urban populations. Understanding these disparities is essential for improving care pathways and outcomes for all patients.
Data Highlights
Characteristic
Rural Patients
Urban Patients
Right-sided tumors
Higher odds (aOR 1.76)
Rectal tumors
Higher odds (aOR 1.52)
RAS mutations
11.2%
1.6% (p=0.021)
Delay to chemotherapy initiation
66.5 days
55 days (p=0.011)
Overall survival (median)
250 days
270 days (p=0.774)
Key Findings
Rural patients had higher odds of right-sided (aOR 1.76) and rectal tumors (aOR 1.52).
RAS mutations were more frequently identified in rural patients (11.2% vs. 1.6%, p=0.021).
Patients in rural laboratories experienced longer delays in chemotherapy initiation (66.5 vs. 55 days, p=0.011).
Overall survival did not differ significantly by residency (median 250 vs. 270 days, p=0.774).
Older age and poorer performance status were primary predictors of mortality.
Clinical Implications
Healthcare providers should be aware of the systemic therapy delays faced by rural patients with mCRC and consider strategies to mitigate these delays. Ensuring equitable access to diagnostic services is essential for optimizing treatment pathways and outcomes.
Conclusion
The study highlights the need for targeted improvements in the care pathway for rural patients with mCRC, particularly regarding diagnostic and treatment delays, while noting that survival rates remain comparable across geographic locations.
