Distance as a barrier to cancer diagnosis and treatment: review of the literature

Ambroggi, Massimo; Biasini, Claudia; Fornari, Fabio; Cavanna, Luigi

doi:10.1093/annonc/mdv347.12

Cited by 41 publications

(58 citation statements)

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“…Furthermore, in line with previous research, our study found that increased travel burden was associated with diagnosis at a later stage of cancer. 8 In one study, the diagnosis of cancer at an earlier stage allowed for less invasive treatments, as well as less treatment altogether, and therefore, lower incurred healthcare costs. 20 Non-medical financial costs and high travel burden are acknowledged by the President's Cancer Panel as key barriers to health care access, 21 and are likely to be more pronounced in more underserved populations, acting as a barrier to access to care.…”

Section: Discussionmentioning

confidence: 99%

“…3,5 Moreover, patients with rare cancers frequently face a travel burden, including additional travel time and costs, likely influencing access to both adequate and timely diagnosis and treatment services. 8 Previous literature has demonstrated that high travel burden is associated with a delay in diagnosis, leading to more advanced disease at diagnosis, inappropriate treatment, worse prognosis, and lower quality of life. 8 In the case of rare cancers, diagnosis is particularly challenging, resulting in numerous visits to centers with clinical expertise.…”

Section: Introductionmentioning

confidence: 99%

“…8 Previous literature has demonstrated that high travel burden is associated with a delay in diagnosis, leading to more advanced disease at diagnosis, inappropriate treatment, worse prognosis, and lower quality of life. 8 In the case of rare cancers, diagnosis is particularly challenging, resulting in numerous visits to centers with clinical expertise. Since the number of such specialized centers for rare cancers is limited, patients may travel more often and farther relative to patients with other common cancers.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Travel burden associated with rare cancers: The example of Merkel cell carcinoma

Jain¹,

Menzin²,

Lachance

et al. 2019

Cancer Medicine

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Background There are limited data on the travel burden for cancer patients with rare tumor types, such as Merkel cell carcinoma (MCC). Objective The objective of this study was to understand the travel burden of MCC patients. Methods This study used data from an MCC registry at the Seattle Cancer Care Alliance (SCCA). All MCC patients enrolled at SCCA with a valid 3‐digit ZIP code were included. Patients were followed up from January 1, 2012 until their last follow‐up, death, or end of data (January 1, 2017). Travel burden was measured by one‐way travel distance to SCCA from each patient's 3‐digit ZIP code. Patient demographics, tumor characteristics, and follow‐up visit were evaluated and stratified by one‐way driving distance of ≤300 and >300 miles. Results A total of 391 MCC patients were included (68% men, mean age = 67 years [±SD = ±11 years], 67% residing in the West, and 70% white). At diagnosis, 53% of the patients had Stage III or IV MCC. Mean one‐way distance traveled by patients was 1,137 (median: 813) miles, and 57% of patients traveled >300 miles. Compared to patients who traveled ≤300 miles, those who traveled >300 miles were more likely to be <70 years old (46% vs 65%; P < 0.001), were diagnosed with advanced stage (III or IV) MCC (46% vs 59%; P = 0.01), had shorter follow‐up in the cancer registry (mean: 509 vs 212 days; P < 0.001), and had fewer visits during follow‐up (mean: 5.2 vs 2.5; P < 0.001). Conclusions In this single cancer center study, the majority of MCC patients trav‐eled long distances to receive expert care. Longer travel distances appeared to be associated with younger age, a more advanced stage of cancer at study entry and fewer in‐clinic visits, suggesting that travel burden may impact timely and adequate patient care for this rare cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Travel burden associated with rare cancers: The example of Merkel cell carcinoma

Jain¹,

Menzin²,

Lachance

et al. 2019

Cancer Medicine

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“…Although Switzerland has a high hospital density [23], inhabitants of remote regions, peripheral valleys, or mountainous areas may have long travel distances for care. Travel burden has been found to influence the choice of treatment and treatment site, to lower treatment adherence and to worsen prognosis [49,50]. There is also convincing evidence that quality of CRC surgery depends on hospital volume and surgeon's clinical experience [51,52].…”

Section: Discussion In the Context Of The Literaturementioning

confidence: 99%

Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population‐based study

et al. 2018

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Socioeconomic inequalities in cancer stage at diagnosis and survival are important public health issues. This study investigates the association between socioeconomic position (SEP) and colorectal cancer (CRC) stage at diagnosis and survival in Switzerland, a European country with highest level of medical facilities and life expectancy. We used population‐based CRC data from seven Swiss cantonal cancer registries 2001–2008 (N = 10,088) linked to the Swiss National Cohort (SNC). Follow‐up information was available until the end of 2013. SEP was estimated based on education. The association between cancer stage and SEP was assessed using logistic regression models including cancer localization (colon/rectum), sex, age, civil status, urbanity of residence, language region, and nationality (Swiss/non‐Swiss). Survival was analyzed using competing risk regressions reporting subhazard ratios (SHRs) for the risk of dying due to CRC. We observed a social gradient for later stage CRC with adjusted odds ratios (ORs) of 1.11 (95% CI: 0.97–1.19) and 1.28 (95% CI: 1.08–1.50) for middle and low SEP compared to high SEP. Further, single compared to married people had elevated odds of being diagnosed at later stages. Survival was lower in patients with CRC with low SEP in the unadjusted model (SHR: 1.18, 95% CI: 1.07–1.30). After adjustment for stage at diagnosis and further sociodemographic characteristics, significant survival inequalities by SEP disappeared but remained for non‐Swiss compared to Swiss citizens and for patients living in nonurban areas compared to their urban counterparts. Swiss public health strategies should facilitate equal access to CRC screening and optimal CRC care for all social groups and in all regions of Switzerland.

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“…[9][10][11][12][13] These studies generally have found that patients experiencing cost barriers have worse cancer outcomes, and patients who travel farther are more likely to be diagnosed with later-stage disease, have worse prognoses, and receive less definitive treatment. 10,11,14 Multiple other factors also can influence access, including the ability to get to an appointment, office waiting time, and cultural norms of providers and patients. 15 To our knowledge, these factors have not been examined in combination to create a more comprehensive picture of how access may influence racial disparities.…”

Section: Introductionmentioning

confidence: 99%

A multidimensional view of racial differences in access to prostate cancer care

Pollack

Armstrong

Mitra

et al. 2017

Cancer

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Background Racial disparities in prostate cancer treatment and outcomes are widespread and poorly understood. We sought to determine whether access to care, measured across multiple dimensions, contributed to racial differences in prostate cancer. Methods The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer in 2012–2014. Men were surveyed to assess their experiences accessing care (response rate 51.1%). We determined appointment availability at 151 urology practices using simulated patient calls and calculated travel distances using geospatial techniques. We used multivariable logistic regression models to determine the association between five different domains of access—availability, accessibility, accommodation, affordability, and acceptability—and receipt of treatment, perceived quality of care, and doctor-patient communication. Results There were 1907 non-Hispanic white and 394 black men in our cohort. Overall, 85% of men received definitive treatment with no differences by race. Black men were less likely to report high quality of care (69% vs 81%, p<0.001) and good doctor-patient communication than white men (60% vs 71%, p<0.001). In adjusted models, none of the five domains of access were associated with definitive treatment overall or with radical prostatectomy. All access domains were associated with perceived quality of care and communication, though these domains did not mediate racial disparities. Conclusions This study presents the first comprehensive assessment of prostate cancer access, treatment, and patient experience, showing that while access was related to overall perceived quality of care and better doctor-patient communication, it did not appear to explain observed racial differences.

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Distance as a barrier to cancer diagnosis and treatment: review of the literature

Cited by 41 publications

References 0 publications

Travel burden associated with rare cancers: The example of Merkel cell carcinoma

Travel burden associated with rare cancers: The example of Merkel cell carcinoma

Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population‐based study

A multidimensional view of racial differences in access to prostate cancer care

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