Geographic disparities in gastrointestinal cancer care in the United States

Geographic disparities in cancer care remain a critical public health concern in the United States, particularly for gastrointestinal (GI) malignancies that require timely screening, multidisciplinary treatment, and ongoing supportive services. While rural–urban differences in access are well recognized, less is known about how geographic context influences patient-reported barriers, supportive infrastructure, and care navigation across the continuum of GI cancer care. We conducted a nationwide, cross-sectional, web-based survey of U.S. adults assessing access to GI cancer screening, treatment availability, supportive services, and healthcare-related barriers. Respondents self-identified their geographic residence as urban, suburban, or rural. Outcomes were compared across geographic groups using chi-square tests and Kruskal–Wallis tests as appropriate. Multivariable logistic regression was performed to evaluate associations between geographic location and key outcomes, adjusting for age and sex. A total of 123 respondents were included, with 47.2% residing in urban, 39.0% in suburban, and 13.8% in rural areas. Overall screening rates for GI and colorectal cancer were high (84.6%) and did not significantly differ by geography. However, significant geographic disparities were observed in supportive care and access burden. Provision of supportive services following treatment was highest among urban respondents (69.0%) and lowest among rural respondents (35.3%; p = 0.009). Consideration of relocating to improve healthcare access differed by geographic location ( p = 0.049). In adjusted analyses, urban residence was independently associated with increased odds of receiving supportive services and considering relocation for improved access. Geographic disparities in GI cancer care are driven less by differences in screening or perceived quality of care and more by inequities in supportive infrastructure and access burden. Efforts to improve equity should prioritize expansion of supportive services, transportation solutions, and care navigation across all geographic settings.