Association Between Travel Distance and Metastatic Disease at Diagnosis Among Patients With Colon Cancer

Abstract

Purpose Health care access and advanced cancer stage are associated with oncologic outcomes for numerous common cancers. However, the impact of patient travel distance to health care on stage at diagnosis has not been well characterized. Methods This study used a historical cohort of patients with colon cancer in the National Cancer Data Base from 2003 through 2010. The primary outcome, stage at diagnosis, was evaluated using hierarchical regression modeling. A secondary outcome was time to receipt of initial therapy that was evaluated using Cox shared frailty modeling. Results Among 296,474 patients with colon cancer (mean age, 68 ± 13.6 years; 47.6% male; 78.5% white), 3.9% traveled ≥ 50 miles to the diagnosing facility. Fewer black patients, patients with higher income, and patients with lower education traveled longer distances (trend test P < .001 for all). Patients traveling ≥ 50 miles were more likely to present with metastatic disease compared with those traveling less than 12.5 miles (odds ratio [OR], 1.18; 95% CI, 1.12 to 1.24) or 12.5 to 49.9 miles (OR, 1.18; 95% CI, 1.12 to 1.24). In sensitivity analyses, the association was robust to alternate methods of modeling travel distance (quintile stratification or continuous). Travel distance ≥ 50 miles was also associated with a higher likelihood of earlier initiation of therapy compared with travel distance of less than 12.5 miles (hazard ratio [HR], 1.10; 95% CI, 1.08 to 1.13) or 12.5 to 49.9 miles (HR, 1.11; 95% CI, 1.08 to 1.13). Conclusion Advanced colon cancer stage at diagnosis is associated with patient travel distance to health care, which may be a barrier to early cancer screening. Health care reform efforts designed to address only insurance coverage may not mitigate disparities based on difficulties accessing cancer care.

Distance to hospital is not a risk factor for emergency colon cancer surgery

“…Patients with long distances to travel to a hospital performing CRC surgery also tend to show up with more advanced tumour stages [18]. The main reason for not seeking medical advice for symptoms of colon cancer is because the patient does not believe the situation is serious and that the problem will disappear spontaneously [19, 20].…”

Geographic disparities amongst patients with gynecologic malignancies at an urban NCI-designated cancer center

“…Additionally, a patient's socioeconomic status has been associated with their ability to access specialty centers at increasing distance [10][11][12]. Similarly, travel time to health care services has been shown to influence access, utilization and outcomes for patients with various malignancies [9,[11][12][13][14]. For example, women with breast cancer are more likely to present with advanced staged disease, less likely to receive breast conserving surgery and less likely to receive postoperative adjuvant care as the distance from their home to a health care facility increases [13,[15][16][17][18].…”

Small-area geographic and socioeconomic inequalities in colorectal tumour detection in France

“…Late-stage cancer at diagnosis was shown to be associated with higher physician density (Ananthakrishnan et al, 2010) and with patient's travel distance to healthcare providers (Massarweh et al, 2014), whereas no variation in CRC incidence was identified when all-stage cancers were considered (Chirumbole et al, 2009;Ananthakrishnan et al, 2010) in North-American studies. The impact of socioeconomic inequalities on CRC incidence has been the subject of some research (Coughlin et al, 2006;Chirumbole et al, 2009;Clegg et al, 2009), mainly performed in the USA.…”