Rural patients less likely to undergo PET imaging for prostate cancer
Rural patients are much less likely to undergo PET (positron emission tomography) imaging for prostate cancer than their urban counterparts, according to new research.
The modality has seen increasing interest in recent years, given its higher accuracy in detecting metastases compared to standard imaging, among other benefits. However, not all patients may be benefiting equally from the technology, researchers detailed July 4 in the journal Cancer Imaging.
Between 2019 and 2021, rural patients were less likely to undergo PET imaging than those in metro areas (odds ratio of 0.87). This disparity remained true for both rural black patients (0.69) and rural white patients (0.89), based on an analysis of Medicare claims data.
“The observed disparities highlight the importance of targeted initiatives to improve access to advanced diagnostics, especially addressing geographic and racial inequities,” Alexander P. Cole, MD, a urologist and assistant professor at Harvard Medical School, and co-authors concluded. “Future work should explore patient- and provider-level barriers and evaluate implementation strategies to reduce rural-urban differences in advanced prostate cancer care.”
Cole and colleagues pinpointed patients who were newly diagnosed with cancer during the study period, also determining whether they underwent a post-diagnostic PET scan. A total of nearly 496,000 individuals were included in the analysis, with over 79% living in the largest metropolitan areas, 11% in smaller “urban” geographies, and 8% in rural counties.
Those in metro areas underwent PET imaging more often at 8.4% compared to others in urban (7.3%) or rural communities (7.2%), the authors discovered. The modality also more commonly used on white patients versus those who were Hispanic or black. PET imaging was less common among rural residents across all races, but the disparity was more pronounced for black patients. In contrast, these racial differences dissipated when examining urban geographies.
Cole and co-authors speculated on possible reasons for these figures. PET often requires additional on-site equipment and healthcare resources. Plus, the necessary isotopes are produced in a cyclotron or radionuclide generator and transported to imaging facilities for patient injection. Due to their short half-life, some doses may expire “within hours,” limiting access in rural areas where isolation may complicate logistics. This “regional dependency” is potentially reflected in the high variability of PET scan rates, ranging from 2.2% to 20.8% across different hospital referral regions.
“Various strategies are currently being explored to enhance access to advanced imaging procedures, with imaging networks assisted by teleradiology emerging as a particularly promising approach,” the authors noted, also citing mobile PET units as another possibility. “Establishing hub-and-spoke structures may be particularly beneficial for advanced imaging referral in rural communities. In this model, a central facility (hub) provides comprehensive services, while smaller sites (spokes) offer basic diagnostics and could refer patients to the hub. Such networks are already implemented in imaging and treatment, aiming to coordinate care delivery, improve efficiency, and maintain high standards across regions. This model can also incorporate teleradiology to support appropriate referrals and triage. By expanding the availability of subspecialized radiologists, teleradiology can improve not only imaging accessibility but also diagnostic quality, as recently demonstrated in advanced prostate imaging.”
Read much more, including some important potential study limitations, in the open-access, peer-reviewed official journal of the International Cancer Imaging Society here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.