Urban-Rural and Socioeconomic Differences in Patient Knowledge and Perceptions of Genomic Tumor Testing.

Document Type


Publication Date



MCGI, Humans, Neoplasms, Precision Medicine, Surveys and Questionnaires, Socioeconomic Factors, Genomics

JAX Source

JCO Precis Oncol. 2023;7:e2200631








The Maine Cancer Genomics Initiative and this publication were supported by funding from the Harold Alfond Foundation and The Jackson Laboratory. This project was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Grant No. KL2TR002545. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.


PURPOSE Social determinants of health, such as rurality, income, and education, may widen health disparities by driving variation in patients’ knowledge and perceptions of medical interventions. This effect may be greatest for medical technologies that are hard to understand and less accessible. This study explored whether knowledge and perceptions (expectations and attitudes) of patients with cancer toward large-panel genomic tumor testing (GTT), an emerging cancer technology, vary by patient rurality independent of other socioeconomic charac- teristics (education and income).

METHODS Patients with cancer enrolled in a large precision oncology initiative completed surveys measuring rurality, sociodemographic characteristics, and knowledge and perceptions of GTT. We used multivariable linear models to examine differences in GTT knowledge, expectations, and attitudes by patient rurality, education, and income level. Models controlled for age, sex and clinical cancer stage and type.

RESULTS Rural patients had significantly lower knowledge of GTT than urban patients using bivariate models (P = .025). However, this association disappeared when adjusting for education and income level: patients with lower educational attainment and lower income had lower knowledge and higher expectations (P ≤ .002), whereas patients with higher income had more positive attitudes (P = .005). Urban patients had higher ex- pectations of GTT compared with patients living in large rural areas (P = .011). Rurality was not associated with attitudes.

CONCLUSION Patients’ education and income level are associated with knowledge, expectations, and attitudes toward GTT, whereas rurality is associated with patient expectations. These findings suggest that efforts to promote adoption of GTT should focus on improving knowledge and awareness among individuals with low education and income. These differences may lead to downstream disparities in GTT utilization, which should be explored in future research.