{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:54:06Z","timestamp":1790391246012,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Objective(s)<\/jats:title><jats:p>Few studies evaluate the price elasticity of demand or the relationships between costs of access, patient income, treatment decision making and outcome in rural patients with upper gastrointestinal malignancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We queried the National Cancer Database to identify rural patients presenting with clinical stages I\u2013III esophagus, stomach, pancreas, hepatocellular (HCC) and cholangiocarcinoma between 2004 and 2020. Access cost was defined as (distance to treating center)\u2009\u00d7\u2009(regional gas price)\/(regional vehicle fuel efficiency). Patients within the highest (HAC) and lowest (LAC) cost quintiles were selected for analysis. These were subcategorized based on income quartile: High income\/High Access Cost (HI\/HAC), High Income\/Low Access Cost (HI\/LAC), Low Income\/High Access Cost (LI\/HAC), Low Income\/Low Access Cost (LI\/LAC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 9582 patients met inclusion criteria. Median access cost was $26.61 (IQR: [$10.57\u2013$73.70]). Patients in the HI\/HAC cohort were more likely to undergo treatment at academic centers (79.5%, HI\/HAC, 49.6%, HI\/LAC, 78.5%, LI\/HAC, 38.0%, LI\/LAC), undergo neoadjuvant chemotherapy (23.8%, 12.6%, 17.7%, 10.4%) undergo surgery (46.6%, 29.6%, 39.7%, 20.8%), undergo liver transplantation for HCC (30.2%, 5.86%, 18.1%, 2.04%) and demonstrated higher rates of 5\u2010year overall survival (42.4%, 25.6%, 32.2%, 19.0%) than those with HI\/LAC, LI\/HAC, and LI\/LAC cohorts (all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among rural patients undergoing treatment for upper gastrointestinal malignancy elasticity of demand for service varies. Patients willing and able to pay for travel are more likely to receive neoadjuvant chemotherapy, undergo resection and demonstrate improved overall survival.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.28140","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:29:49Z","timestamp":1747355389000},"page":"70-79","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Are Access Costs and Income Associated With Treatment Decision\u2010Making and Clinical Outcomes in Rural Patients Presenting With Upper Gastrointestinal Malignancy?"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8948-7641","authenticated-orcid":false,"given":"Simon S.","family":"Park","sequence":"first","affiliation":[{"name":"Department of Surgery Loyola University Medical Center Maywood Illinois USA"},{"name":"Loyola University Chicago Stritch School of Medicine Maywood Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond A.","family":"Verm","sequence":"additional","affiliation":[{"name":"Department of Surgery Loyola University Medical Center Maywood Illinois USA"},{"name":"Department of Thoracic and Cardiovascular Surgery Loyola University Medical Center Maywood Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaid M.","family":"Abdelsattar","sequence":"additional","affiliation":[{"name":"Loyola University Chicago Stritch School of Medicine Maywood Illinois USA"},{"name":"Department of Thoracic and Cardiovascular Surgery Loyola University Medical Center Maywood Illinois USA"},{"name":"Department of Surgery Edward Hines Jr. Veterans Administration Hospital Hines Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred A.","family":"Luchette","sequence":"additional","affiliation":[{"name":"Department of Surgery Loyola University Medical Center Maywood Illinois USA"},{"name":"Loyola University Chicago Stritch School of Medicine Maywood Illinois USA"},{"name":"Department of Surgery Edward Hines Jr. Veterans Administration Hospital Hines Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talia B.","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall S.","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Surgery Loyola University Medical Center Maywood Illinois USA"},{"name":"Loyola University Chicago Stritch School of Medicine Maywood Illinois USA"},{"name":"Department of Surgery Edward Hines Jr. Veterans Administration Hospital Hines Illinois USA"},{"name":"Department of Surgery, Huntsman Cancer Institute University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-132"},{"issue":"3","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.aogh.2017.09.004","article-title":"Urban\u2010Rural Disparity in Helicobacter Pylori Infection\u2010Related Upper Gastrointestinal Cancer in China and the Decreasing Trend in Parallel With Socioeconomic Development and Urbanization in an Endemic Area","volume":"83","author":"Wen X.","year":"2017","journal-title":"Annals of Global Health"},{"issue":"1","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1186\/s12885-021-08949-4","article-title":"Enhancing Cancer Care of Rural Dwellers Through Telehealth and Engagement (ENCORE): Protocol to Evaluate Effectiveness of a Multi\u2010Level Telehealth\u2010Based Intervention to Improve Rural Cancer Care Delivery","volume":"21","author":"Pal T.","year":"2021","journal-title":"BMC Cancer"},{"issue":"9","key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1200\/OP.22.00122","article-title":"The Road Less Traveled: Transportation Barriers to Cancer Care Delivery in the Rural Patient Population","volume":"18","author":"Wercholuk A. 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