{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T08:36:30Z","timestamp":1792917390952,"version":"4.5.0"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100018071","name":"Knight Cancer Institute, Oregon Health and Science University","doi-asserted-by":"publisher","award":["20241032"],"award-info":[{"award-number":["20241032"]}],"id":[{"id":"10.13039\/100018071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rural esophageal cancer patients experience both fragmented and delayed care. One-size-fits-all interventions aimed at rural communities can be ineffective, as they can vary significantly in population, geographic isolation, and medical specialty availability. Therefore, as a rural health care center, we analyzed the journey of care for our esophageal cancer patients to better understand and serve our community. We aimed to create a framework for how to approach and analyze this complex care continuum for other small communities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Esophageal cancer patients receiving care at a rural cancer center from September 2024 to April 2025 were enrolled. Care journeys were mapped from symptom onset through treatment. Interviews occurred at enrollment and 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-seven patients were enrolled. Nearly half (48%) presented with metastatic disease. Patients on average reported symptoms 85\u00a0days after onset, were diagnosed 137\u00a0days after onset, and started treatment 48\u00a0day after diagnosis. Metastatic patients experienced shorter times to treatment (72 vs 128\u00a0days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.014) compared to locoregional patients. Surgical patients averaged 57\u00a0days from diagnosis to starting neoadjuvant treatment, followed by 97\u00a0days from completing neoadjuvant treatment to esophagectomy. Patients reported disempowerment, difficulty navigating the medical system, and a lack of awareness before diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rural esophageal cancer patients endure prolonged, fragmented, and variable care journeys. Surgical patients, in particular, face delays before esophagectomy. Rural research provides valuable insights for tailoring broader interventions for rural communities. In partnership, rural centers and universities provide both bottom-up and top-down perspectives in defragmenting rural esophageal cancer care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261501893","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:28:46Z","timestamp":1792564126000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Journey of Care for Rural Esophageal Cancer Patients"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0703-7297","authenticated-orcid":false,"given":"Estin","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Surgery, Asante Three Rivers Medical Center"},{"name":"Department of Surgery, Oregon Health & Science University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Kalmeta","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oregon Health & Science University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeka","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Asante Three Rivers Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-8282-z"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/00031348261472862"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.21037\/ccts-23-24"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11050685"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2024.07.004"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.XCS.0000895052.71853.a2"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000819"},{"key":"e_1_3_8_9_2","unstructured":"ORH Defined Urban Rural. 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