By Anne Harding

NEW YORK (Reuters Health) - Lymphoma patients' survival can depend on where they live, and where they get treated, a new study out in the Journal of Clinical Oncology shows.

Low- to intermediate-risk patients living in rural areas fared worse if they got care at a community-based center, rather than a university-based treatment provider, Dr. Fausto R. Loberiza of Nebraska Medical Center in Omaha and his colleagues found.

And for patients with high-risk lymphoma, urban residents treated at an urban, university-based center survived longer than rural residents, as well as longer than urban residents cared for by community-based providers.

Loberiza and his colleagues looked 2,330 patients with lymphoma from Nebraska and nearby states treated between 1982 and 2006. Fourteen percent were urban residents treated at university-based centers; 35 percent were urbanites treated by community-based providers; 14 percent were rural residents who got university-based care; and 37 percent were rural residents receiving community-based care.

Survival for all urban patients and rural patients cared for at university centers was similar, but rural community-treated patients with low- to intermediate-risk disease were 37 percent more likely than urban university-treated patients to die, and 26 percent more likely to die than their rural peers who got university-based care.

And for high-risk lymphoma patients, mortality risk was higher for all rural patients and community-treated urban patients than it was for urban university-treated patients.

Patients treated at community-based centers were less likely than those treated at university-based centers to receive cutting edge treatments such as stem cell transplants, Loberiza and his colleagues found. The differences in outcomes are likely related to this, the researcher said.

Still, "We really need to avoid saying if you are from rural areas and decide to stay there for treatment, your outcome will be bad," Loberiza told Reuters Health via E-mail. "Patients especially older rural folks, like to stay closer to their homes for their care for support, which is also important and may have some outcome implications."

Better care coordination could go a long way toward improving outcomes for rural patients, he added, while patients themselves need to take responsibility for asking about new treatments and making sure they get the follow-up care they need. "If you decide to stay closer to home for cancer treatment, you may need to be more vigilant about possible recurrence and complications," he said.

Strategies like telemedicine can be used to help improve care coordination in rural areas, noted Loberiza, because while this is not a new idea, it's still underused. Another approach, he added, "is increasing the capacity of rural health workers ... to identify and be more familiar with what to watch for."

He added: "The university medical centers can therefore play a major role in this area. Cooperative groups that link community with university-based oncologists should be explored."

SOURCE: Journal of Clinical Oncology, online September 14, 2009.

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