(148) Does Rurality Affect Stage and Prognosis of Salivary Gland Malignancy?

Introduction: The incidence of salivary gland tumors has increased in the last few decades. Much of this increase is attributable to diagnosis of tumors measuring less than 2-cms. Geography, rural vs metropolitan, has been shown to be a major factor in the early diagnosis and treatment of cancer. The goal of this study is to investigate whether rurality affects salivary gland cancer stage at presentation and treatment outcomes.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database, from 2011 to 2019, was queried for patients with a primary diagnosis of salivary gland malignancy. A statistical analysis was conducted using multivariate methods to compare various factors such as incidence, cancer stage, time to treatment, and mortality between rural and metropolitan populations. Demographic, socioeconomic, and other health-related factors were accounted for to eliminate potential confounding factors. The analysis used a multivariate log-link generalized linear model, with binomial and exponential distributions, to examine tumor stage and time-to-treatment respectively. To evaluate survival, a multivariate Cox Proportional Hazards (CPH) regression was applied.

Results: 10,283 patients were eligible for analysis, with 88.33% living in metropolitan areas. Patients living in rural areas were no more likely to have advanced tumor stage at presentation (Odds Ratio: 1.038, p=0.631, CI: [0.891, 1.209]) or longer time-to-treatment 6.80% (p=0.318, CI: [-6.12%, 21.53%]). CPH regression demonstrated no significant difference in survival in metropolitan areas, with a hazard ratio of 0.91 (p=0.22, CI: [0.71, 1.04]).

Conclusions: In our study there were no significant differences in tumor stage, time to treatment and survival rates between metropolitan and rural patients with salivary gland cancer. This is noteworthy as these findings contrast with previous research on lung and breast cancer, which have shown that patients in rural areas tend to have more advanced stages of the disease, longer time to treatment, and worse prognosis.