Multiple studies have shown health care disparities and inferior health care related outcomes in the rural population compared to urban population. Our hypothesis is that patients with advanced GU cancers who present for care at a tertiary cancer hospital have similar health care quality metrics representing opportunity for cancer care regardless of where they live.


Geographic information was retrospectively collected on medical oncology patients through an institutional cancer registry from Oct 1, 2017 to Sep 30, 2021. Data on patients’ demographics, tumor characteristics, systemic therapy, and various quality metrics representing frontiers of cancer treatment were concurrently collected. We used the rural-urban commuting area (RUCA) codes ( from 2010 census to classify urban (1-3) and rural (4-10) areas. The median income data were obtained from population studies center at University of Michigan (


A total of 2312 patients with GU cancers were treated in this period, including 1912 of them from urban area (82.7%). The top 3 diagnoses were metastatic prostate cancer (n=679), metastatic bladder cancer (n=184) and metastatic kidney cancer (n=172). The table shows various metrics of quality of care representing frontiers of cancer treatment (number of lines of treatment, clinical trial enrollment, genomic profiling etc.) in patients from urban versus rural areas. The figures show visualization of those data based on zip code.


Despite higher median income observed in urban population, there was no difference in metrics in level of care in patients with advanced GU cancer from urban versus rural areas. These hypothesis generating data show that access to care (as available in a tertiary cancer hospital) can mitigate the difference in quality of health care of urban versus rural patients.

Table. Spatial patterns of metastatic genitourinary cancers in Utah
Figure 1
Figure 1.Spatial pattern of age group in patients with metastatic GU cancer
Figure 2
Figure 2.Spatial pattern of treatment received in metastatic prostate cancer