Urban And Rural Differences In Outcomes Of Head And Neck Cancer (Hnc).

6570 Background: Management of HNC is becoming more specialized where effective treatments frequently require multidisciplinary and multimodality care. Concerns exist that access to such complex care may be suboptimal for marginalized subsets of the population. Our aim was to examine for potential urban and rural disparities in HNC outcomes within a population-based single payer healthcare system. Methods: All patients diagnosed with HNC from 2001 to 2010 and referred to any 1 of 5 regional comprehensive cancer centers in British Columbia, Canada were reviewed. Based on census data, patients were classified into 4 categories: 1) rural 2) small urban 3) moderate urban and 4) large urban areas. Kaplan Meier methods and Cox regression were used to correlate site of residence with overall survival (OS), controlling for prognostic factors that included socio-demographics and other tumor and treatment-related characteristics. Results: A total of 3,036 patients were included: median age was 64 years, 74% were men, and 32% were ECOG 0/1. The majority resided in large urban areas (55%) followed by rural (22%), moderate urban (13%), and small urban (10%). There were no clinically significant differences in baseline characteristics across the 4 groups. In multivariate-adjusted models, advanced age >/= 65 years (HR 1.58, 95%CI 1.21-2.06, p<0.001), ECOG 2+ (HR 4.20, 95%CI 2.41-4.93, p<0.001), and lack of multimodality treatment (HR 2.88, 95%CI 1.72-4.81, p<0.001) correlated with inferior OS, but site of residence did not (Table). In subgroup analyses that stratified by type of treatment (radiation, chemotherapy, and/or surgery) and anatomic location of HNC (oral cavity, oropharynx, larynx, hypopharynx, nasopharynx), OS remained similar irrespective of urban or rural residence. Conclusions: Urban-rural differences in outcomes were not observed. The centralization of HNC management in this large population-based cohort represents an appropriate model of care for cancers in which multimodality treatments are increasingly complex and where disparities in access may be prevalent. Residence HR for death 95%CI P-value Rural 1.0 -- -- Small urban 1.27 0.77-2.10 0.35 Moderate urban 0.84 0.52-1.37 0.49 Large urban 1.19 0.80-1.56 0.51