# Rurality, Health Care Resource Use, and Care Trajectories in Patients With Head and Neck Cancer

## TL;DR

This study finds that patients with head and neck cancer in rural Canada use more healthcare resources and have different care paths compared to urban patients.

## Contribution

The study identifies specific differences in healthcare resource use and care trajectories between rural and urban head and neck cancer patients in Canada.

## Key findings

- Rural patients had higher 30-day hospital readmission rates and more emergency department visits.
- Rural patients experienced longer time to first treatment and different post-discharge care transitions.
- Rural male patients had longer surgical hospital stays compared to urban male patients.

## Abstract

This cohort study evaluates differences in health care resource use between patients with head and neck cancer living in urban and rural areas in Canada.

Does health care resource use or care trajectory differ between patients with head and neck cancer living in urban and rural areas?

In this cohort study of 2189 patients with head and neck cancer in Alberta, Canada, health care resource use was significantly greater in patients living in rural regions at the time of diagnosis. Care trajectories differed between patients with head and neck cancer living in urban and rural areas.

These findings suggest that patients with head and neck cancer living in rural areas have higher health care resource use and different care trajectories than urban patients, indicating that guidelines tailored to the needs of patients diagnosed with head and neck cancer living in rural areas is warranted.

Head and neck cancer (HNC) epidemiology varies geographically, and rural populations (typically less affluent) may face barriers accessing cancer care, which could lead to worse outcomes.

To compare health care resource use between patients with HNC living in urban and rural areas.

Retrospective cohort study in Alberta, Canada. Participants were adult patients (aged ≥18 years) diagnosed with HNC with at least 1 year of posttreatment follow-up between January 2012 and September 2020. Data were analyzed from August to September 2024.

Rural location of residence at HNC diagnosis, defined using the forward sortation area of the patients’ postal code.

The primary outcomes were health care resource use and patient care trajectories, including hospital length of stay, 30-day hospital readmissions, emergency department visits, time from diagnosis to first treatment, first type of practitioner seen after hospital discharge, and most common practitioner-to-practitioner transitions.

The cohort included 2189 patients with a median (IQR) age of 63 (55-71) years, who were mostly men (1557 patients [71.1%]) with stage IV cancer (1149 patients [52.5%]) of the tongue (640 patients [29.2%]), of which 375 (17.1%) lived in a rural area. There was no difference in cumulative hospital length of stay between urban and rural patients; however, male patients living in rural areas had a longer surgical hospital length of stay than male patients living in urban areas (incidence rate ratio, 1.24; 95% CI, 1.03-1.50). Patients living in rural areas had more 30-day hospital readmissions (63 patients [16.8%] vs 183 patients [10.1%]) and emergency department visits (median [IQR], 8 [3-17] vs 4 [2-9]) than their urban counterparts. Time to first treatment was longer in patients living in rural areas compared with patients living in urban areas (median [IQR], 64 [46-95] days vs 57 [40-84] days). Patients living in rural areas without comorbid conditions had greater odds of being discharged directly to the care of a general practitioner after a hospital stay than urban patients (odds ratio, 1.97; 95% CI, 1.23-3.15).

In this cohort study of patients with HNC, living in rural areas was associated with higher health care resource use than patients living in urban areas. Recommendations specific to patients with HNC living in rural areas may be warranted given these differences.