DMS study examines rural cancer care

by Michael Coburn | 11/29/07 1:46am

Cancer patients from rural areas are diagnosed with cancer earlier than those from urban areas, two Dartmouth Medical School professors discovered. Professors of surgery Sam Finlayson and Ian Paquette helped disprove a long-held belief that rural patients wait longer to report their illness to a doctor.

Paquette said he did not expect the reported result.

"Anecdotally, I see a lot of patients present with really late stage diseases," Paquette said. "We would wonder how could this patient have waited this long. It's a common conception that rural patients present with later stage diseases. We wanted to put that to the test."

Paquette said he and Finlayson have a personal interest in the results of his research as surgeons in a rural area.

"We're both very interested in rural health and rural surgery," Paquette said. "In the environment we practice up here, we see a lot of late stage diseases."

Paquette and Finlayson spent nearly four months comparing approximately 300,000 lung and colon cancer patients from rural and urban counties. The two diseases are highly prevalent

"Particularly colon and lung cancer are both common diseases," Paquette said. "Both of us see them in our daily practice."

The study also identified other factors that appeared to correlate with an increased wait for diagnosis. Patients who were African-American, divorced, male, language isolated or poor were more likely to report their cancer at a later stage.

Rural patients tended to be older and poorer, while urban patients were more likely to be African-American, divorced or language isolated. Taking into account all these factors, rural patients were more likely to report cancer earlier.

The study also found that lung cancer patients were more likely to be diagnosed late as opposed to colon cancer patients. According to Paquette, 70 percent of lung cancer patients were not diagnosed until their cancer had progressed to stage three or four, while 40 percent of colon cancer patients waited that long. Paquette said this difference is due to a lack of national standards for lung cancer screening.

"I think a major affect of this study is to really highlight the overall number of patients presenting with late stage disease," he said. "This study highlights the need of public health officials to try to find better measures to implement screening."

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