Impact of Rurality on Access to Care in Adult Patients with Sinonasal Squamous Cell Carcinoma

Introduction: Social determinants of health (SDOH), such as uninsured, race/ethnicity, and low-income status have been identified as risk factors impacting access to care and survival in sinonasal malignancies. Other SDOHs, including rurality and distance to adequate healthcare, have increasingly been shown to be prognosticators and may also play a role in patients with sinonasal malignancies. We sought to understand the role of rurality as a prognostic factor in sinonasal malignancy and squamous cell carcinoma (SCC). Methods: A retrospective cohort study of the Utah Cancer Registry database from 1973 to 2019 was performed with patients delineated into Frontier (< 6 people/sq mi), Rural (6-99 people/sq mi), and Urban (>100 people/sq mi) populations based on geographic information system mapping. Results: Of the 156 patients with SCC (68.0% male, 96.8% white, 96.2% non-Hispanic), 9 (5.8%) were Frontier, 36 (23.1%) were Rural, and 111 (71.2%) were Urban. Frontier, Rural and Urban patients resided 109.2±59.4, 55.5±55.7 miles from their treatment facility, with an average of 9.2 ± 10.6 miles, respectively (P < 0.001). As part of treatment, 74.2-80.0% of patients underwent surgery, 35-52.4% had radiation, and 10-23.6% underwent chemotherapy. Kaplan-Meier survival analysis demonstrated significantly improved survival in Urban patients (median survival 12.3 months) compared with Frontier (10.1 months) and Rural (10.4 months) patients (P = 0.04, log-rank test). Conclusion: Frontier and Rural patients with SCC resided farther from their care facility with worsened survival compared to Urban patients. The presence of a centralized National Cancer Institute designated tertiary care facility in Utah may improve regional patient access to care and survival, which requires future study. These data help compare the treatment infrastructure of rural Utah with other rural US areas.