Demographics and access to head and neck cancer care in rural areas compared to urban areas in Germany

Julius M Vahl; Gabriele Nagel; Ayla Grages; Matthias Brand; Adrian von Witzleben; Michael Sonntag; Marie-Nicole Theodoraki; Jens Greve; Tsima Aboukors; Michael Denkinger; Dhayana Dallmeier; Christian Idel; Thomas K Hoffmann; Simon Laban

doi:10.1002/cam4.6505

Demographics and access to head and neck cancer care in rural areas compared to urban areas in Germany

Cancer Med. 2023 Sep;12(18):18826-18836. doi: 10.1002/cam4.6505. Epub 2023 Sep 14.

Affiliations

¹ Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany.
² Department of Epidemiology and Medical Biometry, University Medical Center Ulm, Ulm, Germany.
³ Agaplesion Bethesda Ulm, Geriatric Research Ulm University and Geriatric Center, Ulm, Germany.
⁴ Department of Otorhinolaryngology, University Hospital Schleswig-Holstein, Lübeck, Germany.

Abstract

Background: Demographic development in rural and urban areas differs substantially. Demographics and access to specialized head and neck cancer centers may affect head and neck cancer patients' (HNCP) outcomes. Here, we compare epidemiological indicators and outcomes of HNCP in rural and urban Germany.

Patients and methods: In a retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) between 2002 and 2017, 212,920 HNCP were included. Incidence, demographics, travel distance to specialized centers, and ground values were compared between rural and urban areas with a focus on their association with patient outcomes.

Results: The mean age of HNCP was significantly higher in urban areas (mean difference = 1.4 years; p < 0.0001), but increased at a comparable rate (p = 0.26) in rural and urban areas during the observation period. Gender imbalance was higher in rural areas (mean ratio of men/women: 4.1 vs. 3.1; p < 0.0001), but showed a comparable trend toward equilibration in both, rural and urban districts (p = 0.46). The portion of HNCP of the entire HNCP population living in urban areas increased from 55.9% in the year 2002 to 76.4% in the year 2017. There was no significant difference or change in the ratio of advanced to low UICC stage during the observation period (p = 0.26). However, travel distances to medical centers were higher in rural areas, especially (p < 0.0001) in East Germany. Median survival of HNCP in rural areas was significantly lower than in urban areas (42 months [SEM = 0.7; CI: 40.5-43.5] vs. 54 months [SEM = 1.2; CI: 51.7-56.3]; p < 0.0001) in East Germany, whereas in West Germany no significant difference was observed (59 months [SEM = 0.8; CI: 57.4-60.6] vs. 60 months [SEM = 0.5; CI: 59.0-61.0]; p = 0.15).

Conclusions: Place of residence contributes to survival outcome of HNCP. Access to specialized care and socioeconomic factors could be improved in East Germany.

Keywords: East Germany; demographic change; industrial country; peripheral region.