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Background: Colorectal cancer represents a significant cause of morbidity and mortality, particularly in Appalachia where high mortality from colorectal cancer is more prevalent. Adherence to treatment guidelines leads to improved survival. This paper examines determinants of guideline concordance for colorectal cancer., Methods: Colorectal cancer patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009). Final sample size after exclusions was 2,932 stage I-III colon, and 184 stage III rectal cancer patients. The 3 measures of guideline concordance include adjuvant chemotherapy (stage III colon cancer, <80 years), ≥12 lymph nodes assessed (resected stage I-III colon cancer), and radiation therapy (stage III rectal cancer, <80 years). Bivariate and multivariate analyses with clinical, sociodemographic, and service provider covariates were estimated for each of the measures., Results: Rates of chemotherapy, lymph node assessment, and radiation were 62.9%, 66.3%, and 56.0%, respectively. Older patients had lower rates of chemotherapy and radiation. Five comorbidities were significantly associated with lower concordance in the bivariate analyses: myocardial infarction, congestive heart failure, respiratory diseases, dementia with chemotherapy, and diabetes with adequate lymph node assessment. Patients treated by hospitals with no Commission on Cancer (COC) designation or lower surgical volumes had lower odds of adequate lymph node assessment., Conclusions: Clinical, sociodemographic, and service provider characteristics are significant determinants of the variation in guideline concordance rates of 3 colorectal cancer measures., (© 2013 National Rural Health Association.)

Purpose: The mortality rate of laryngeal cancer has been trending downward with the use of more effective surgical, radiation, and systemic therapies. Although the best treatment for this disease is not entirely clear, there is a growing consensus on the value of primary radiotherapy as an organ preservation strategy. This study examines urban-rural differences in the use of radiotherapy as the primary treatment for early stage laryngeal cancer in Pennsylvania., Experimental Design: The sample was drawn from the Pennsylvania tumor registry, which lists 2,437 laryngeal cancer patients diagnosed from 2001 to 2005. We selected 1,705 adults with early stage squamous cell carcinoma of the larynx for our analysis. Demographic data and tumor characteristics were included as control variables in multivariate analyses. Rurality was assigned by ZIP code of patient residence., Results: Controlling for demographic and clinical factors, rural patients were less likely than urban patients to receive radiotherapy as the primary treatment modality for early stage larynx cancer (OR 0.740, 95% CI 0.577-0.949, P = .0087). No other associations between rural status and treatment choice were statistically significant., Conclusions: Relatively fewer rural patients with larynx cancer are treated primarily with radiation therapy. Further investigations to describe this interaction more thoroughly, and to see if this observation is found in larger population data sets, are warranted., (© 2014 National Rural Health Association.)