A study by researchers at the University of Nebraska Medical Center has found that survival for patients with lymphoma may depend on where they live and where they get treated.
The study, published recently in the Journal of Clinical Oncology, compared survival outcomes among four groups: patients living in urban or rural areas treated by university-based or community-based oncologists.
Patients who live in rural areas and receive treatment in their communities had a 37 percent more chance of dying compared to patients living in urban areas treated at a university. They also had a 26 percent more chance of dying compared to rural patients treated at a university.
Five-year survival rates for patients were as follows:
· 66 percent for patients living in urban areas treated by university-based oncologists;
· 61 percent for patients living in rural areas treated by university-based oncologists;
· 59 percent for patients living in urban areas treated by community-based oncologists; and
· 51 percent for patients living in rural areas treated by community-based oncologists.
The study also found that among high-risk patients, those living in urban areas treated by university-based oncologists had a higher rate of survival than all the other groups.
“The study highlights that despite the increase in new and innovative treatments for lymphoma, rural patients are less likely to receive optimal treatment,” said Fausto Loberiza, M.D., associate professor at UNMC and lead investigator. “This disparity can be due to many factors, some of which relates to the type of treatments offered or not offered. We need to close this gap.”
He said the study suggests that a patient’s area of residence in itself may be an independent risk factor. “We think this may be related to a rural patient’s logistical support structure which may prevent them from acquiring consistent quality care, probably because of longer distance traveled,” he said.
The retrospective study evaluated 2,330 lymphoma patients, from Nebraska and surrounding states, between 1982 and 2006.
James Armitage, M.D., senior author of the study, said the study is important in a variety of ways.
“The study emphasizes the role of university medical centers in reaching out to community doctors to improve the care and outcomes of patients regardless of where they live. It makes us think about how we can improve on delivering care,” said Dr. Armitage, Joe Shapiro Professor of Medicine in the UNMC Department of Internal Medicine. “For the last 25 years, we’ve been fortunate that in Nebraska we’ve been developing partnerships throughout the state that allow us to work together to take advantage of things in private practice and at academic medical centers.
Dr. Armitage said the Nebraska Lymphoma Study Group, a group he established in 1982, encourages collaboration between community-based and university-based oncologists and pathologists in Nebraska and surrounding states. It enables central diagnosis and disease staging.
Dr. Loberiza said the results of the study should not be interpreted to mean patients should only be treated at university hospitals.
“Some rural patients prefer to stay closer to home,” Dr. Loberiza said. “Care in the rural community can also be less expensive as it precludes having to make strenuous trips to a distant provider in an unfamiliar city.
“However, the study suggests that when patients decide to get treatment closer to home, they need to be vigilant and may do more follow-up care. These factors are not trivial as cancer treatment in general, when delivered closer to home, has been shown to maintain or improve the patient’s quality of life through the support of family and friends.”
The study was supported in part by the National Cancer Institute, Department of Health and Human Services, and the UNMC Eppley Cancer Center.
UNMC is the only public health science center in the state. Its educational programs are responsible for training more health professionals practicing in Nebraska than any other institution. Through their commitment to education, research, patient care and outreach, UNMC and its hospital partner, The Nebraska Medical Center, have established themselves as one of the country’s leading centers in cancer, transplantation biology, bioterrorism preparedness, neurodegenerative diseases, cardiovascular diseases, genetics, biomedical technology and ophthalmology. UNMC’s research funding from external sources exceeds $100 million annually and has resulted in the creation of more than 3,200 highly skilled jobs in the state. UNMC’s physician practice group, UNMC Physicians, includes 513 physicians in 50 specialties and subspecialties who practice primarily in The Nebraska Medical Center. For more information, go to UNMC’s Web site at www.unmc.edu.
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