{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T14:11:18Z","timestamp":1762611078748,"version":"build-2065373602"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T00:00:00Z","timestamp":1728000000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of the liver and has the worst prognosis of any tumor arising from the liver, with a 5\u2010year survival as low as 10%. However, whether the rurality of a patient's residence impacts care received and survival has not been well studied. We aimed to assess differences in care patterns associated with the rurality of patient's residences and their impact on survival outcomes, hypothesizing that patients in rural areas would experience lower survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients diagnosed with ICC between 2010 and 2020 were identified in the Iowa Cancer Registry. Chi\u2010square tests were used to compare values categorical variables by rural\/urban status. Cox proportional hazards regression was used to determine associations with cancer\u2010specific mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 672 patients diagnosed with ICC during the study period, 53%, 27%, and 21% resided in metropolitan, micropolitan, and rural areas, respectively. There were no significant differences in age, sex, stage at diagnosis, the proportion receiving chemotherapy within 12 weeks of diagnosis, and undergoing surgery across all groups. Additionally, the proportion receiving definitive care at a National Cancer Institute (NCI) designated center was comparable across the three groups (37% metro vs. 43% micro vs. 35% rural). However, rural residents had the highest proportion of traveling \u2265\u200950 miles for definitive care (22% metro vs. 41% micro vs. 56% rural). In multivariable analysis of patients with Stage 1\u20133 disease, younger age, receipt of chemotherapy, surgery, and definitive care at an NCI center were independently associated with decreased mortality risk. However, rural residence was not significantly associated with survival (HR: 0.64 [95% CI: 0.38\u20131.06]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Similar to other complex cancer diagnoses, we found that definitive care at an NCI center was associated with decreased mortality risk for patients with ICC. Although rural residence was not independently associated with survival in this cohort, rural residents traveled significantly longer distances to access definitive care. This highlights a crucial need to improve access to specialized centers for complex cancer care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.27939","type":"journal-article","created":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T08:03:47Z","timestamp":1728029027000},"page":"450-456","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Care Patterns and Outcomes for Intrahepatic Cholangiocarcinoma by Rurality of Patient Residence in a Midwestern State"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1960-5790","authenticated-orcid":false,"given":"Mohammed O.","family":"Suraju","sequence":"first","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darren M.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda R.","family":"Kahl","sequence":"additional","affiliation":[{"name":"College of Public Health University of Iowa Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"McCracken","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Maduokolam","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Grimmett","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Komlan","family":"Guedeze","sequence":"additional","affiliation":[{"name":"American University of Antigua College of Medicine Coolidge Antigua and Barbuda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Nash","sequence":"additional","affiliation":[{"name":"College of Public Health University of Iowa Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aziz","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver. \"EASL\u2010ILCA Clinical Practice Guidelines on the Management of Intrahepatic Cholangiocarcinoma 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