Rural–Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study

SIMPLE SUMMARY: Rural residence has been associated with poor access to healthcare and accordingly lower odds of receiving definitive treatment. Patient care experiences are important indicators of the quality of care delivered and are highly valued by patients. Although rural–urban disparities in prostate cancer care are evident, it is unknown how these disparities are associated with PCEs among PCa survivors. In this retrospective cohort study, which included 3379 older PCa survivors at intermediate-to-high risk of disease progression, we evaluated the rural–urban differences in patient care experiences according to receipt of definitive treatment. We found rural PCa survivors were less likely to receive treatment. Treated rural PCa survivors reported better access to care, while untreated rural PCa survivors reported poorer care access and experiences compared to their large metro counterparts. We also explored rural–urban disparities in receipt of definitive treatment across different geographic regions. This study highlights the importance of conducting subgroup analysis to uncover any important heterogeneous care experiences among cancer survivors. ABSTRACT: Background: We sought to evaluate rural–urban disparities in patient care experiences (PCEs) among localized prostate cancer (PCa) survivors at intermediate-to-high risk of disease progression. Methods: Using 2007–2015 Surveillance Epidemiology and End Results (SEER) data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, we analyzed survivors’ first survey ≥6 months post-diagnosis. Covariate adjusted linear regressions were used to estimate associations of treatment status (definitive treatment vs. none) and residence (large metro vs. metro vs. rural) with PCE composite and rating measures. Results: Among 3779 PCa survivors, 1798 (53.2%) and 370 (10.9%) resided in large metro and rural areas, respectively; more rural (vs. large metro) residents were untreated (21.9% vs. 16.7%; p = 0.017). Untreated (vs. treated) PCa survivors reported lower scores for doctor communication (ß = −2.0; p = 0.022), specialist rating (ß = −2.5; p = 0.008), and overall care rating (ß = −2.4; p = 0.006). While treated rural survivors gave higher (ß = 3.6; p = 0.022) scores for obtaining needed care, untreated rural survivors gave lower scores for obtaining needed care (ß = −7.0; p = 0.017) and a lower health plan rating (ß = −7.9; p = 0.003) compared to their respective counterparts in large metro areas. Conclusions: Rural PCa survivors are less likely to receive treatment. Rural–urban differences in PCEs varied by treatment status.