Association Between Rurality and Lung Cancer Treatment Characteristics and Timeliness

Document Type


Publication Date

Fall 2019


access, rural, cancer, treatment, MRHRC, Cutler Institute, Muskie School of Public Service, faculty and staff scholarship

Publication Title

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association


BACKGROUND: Lung cancer is the leading cause of cancer-related mortality in the United States, and rural states bear a greater burden of disease.

METHODS: We analyzed tumor registry data to examine relationships between rurality and lung cancer stage at diagnosis and treatment. Cases were from the Maine Cancer Registry from 2012 to 2015, and rurality was defined using rural-urban commuting areas. Multivariable models were used to examine the relationships between rurality and treatment, adjusting for age, sex, poverty, education, insurance status, and cancer stage.

RESULTS: We identified 5,338 adults with incident lung cancer; 3,429 (64.2%) were diagnosed at a late stage (III or IV). Rurality was not associated with stage at diagnosis. For patients with early-stage disease (I or II), rurality was not associated with receipt of treatment. However, for patients with late-stage disease, residents of large rural areas received more surgery (10%) compared with metropolitan (9%) or small/isolated rural areas (6%), P = .01. In multivariable analyses, patients in large rural areas received more chemotherapy (OR 1.48; 95% CI: 1.08-2.02) than those in metropolitan areas. Patients with early-stage disease residing in small/ isolated rural areas had delays in treatment (median time to first treatment = 43 days, interquartile range [IQR] 22-68) compared with large rural (34 days, IQR 17-55) and metropolitan areas (35 days, IQR 17-60), P = .0009.

CONCLUSION: Rurality is associated with differences in receipt of specific lung cancer treatments and in timeliness of treatment.


For further information, contact Kathleen Fairfield, MD, MPH, DrPH, Cener for Outcomes Research and Evaluation, Maine Medical Center, 509 Forest Avenue, Suite 200, Portland, ME 04101; email: fairfk@mmc.org

This research was funded by the Bristol-Myers Squibb Foundation, Maine Cancer Foundation, and the Maine Economic Improvement Fund at the University of Southern Maine.

The authors thank all of the individual and organizational members of the Maine Lung Cancer Coalition, including Lance Boucher, Rebecca Boulos, Anne Conners, Lee Gilman, Natalie Morse, Jessica Reed, Katherine Ryan, the American Lung Association, American Cancer Society, Central Maine Medical Center, Chest Medicine Associates, Eastern Maine Medical Center, FreeME from Lung Cancer, FSG, Harvard Law School Center for Health Law & Policy Innovation, Lung Cancer Alliance, Maine Center for Disease Control & Prevention, Maine Medical Center, Maine Public Health Association, Maine Quality Counts, MaineGeneral Medical Center, MaineHealth, MaineHealth Center for Tobacco Independence, Rinck Advertising, the University of Southern Maine, the MLCC Stakeholder Advisory Board, and the MLCC Patient & Family Advisory Group.

Funding Organization

Bristol-Myers Squibb Foundation; Maine Cancer Foundation; Maine Economic Improvment Fund at the University of Southern Maine