Examining the Effect of Travel Distance to Pediatric Cancer Centers and Rurality on Survival and Treatment Experiences: A Systematic Review

Abstract

Accessing pediatric cancer treatment remains problematic for rural families or those living at increased distances from specialized centers. Rural adult cancer patients or those living far removed from treatment may present with later stage disease, receive different treatments than their closer counterparts, and experience worsened survival. While the financial and psychosocial strain of increased travel is well documented, effects of travel distance on similar outcomes for pediatric cancer patients remain ill-defined. We conducted a systematic review to synthesize literature examining the effect of travel distance and/or rurality (as a proxy for distance) on pediatric cancer treatment experiences and survival outcomes. Included studies examined travel distance to specialized centers or rural status for patients above 21 years of age. Studies were excluded if they focused on financial or quality of life outcomes. We analyzed 24 studies covering myriad malignancies and outcomes, including location of care, clinical trial participation, and likelihood of receiving specialized treatments such as stem cell transplants or proton beam therapy. Most were retrospective, and 9 were conducted outside the United States. While some studies suggest rural patients may experience worsened survival and those traveling furthest may experience shorter hospitalization times/rates, the available evidence does not uniformly assert negative effects of increased distance.

Neuroblastoma survival in South African children is more influenced by biological than socioeconomic factors

“…21 This finding is supported by a recent systematic review, which also found an association between rural status and poorer survival in paediatric cancer, while the association between actual travel distance and survival was less consistent. 23 While there initially appeared to be a survival benefit to shorter distance between residence and POU, the supposed benefit remained similar regardless of the distance analysed (20 km, 30 km, 40 km, 50 km, 100 km) and was not significant when analysed without the inclusion of international participants (Table 2). While these international patients did have the greatest distance to travel between place of residence and treating facility, their survival was influenced by additional factors such as having the financial means to seek privately funded medical care in a different country.…”

Barriers and facilitators to cancer clinical trial enrollment and participation among rural populations: a scoping review protocol

“…Examining the effect of travel distance to pediatric cancer centers and rurality on survival and treatment experiences 17 This review focuses on pediatric patients' survival and treatment experiences. The proposed review will focus on adult populations and will not examine survival and treatment experiences.…”

“…A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis was conducted and eight similar systematic reviews were identified. Table 1 details each systematic review and how they differ from our proposed review 5,17-23 …”

“…Table 1 details each systematic review and how they differ from our proposed review. 5,[17][18][19][20][21][22][23] The objective of this scoping review will be to determine what is known about rural populations regarding enrollment and participation in cancer therapeutic trials and early detection trials, including barriers and facilitators affecting enrollment and Table 1: Identified systematic reviews and how they differ from the proposed review…”

A Decision Support Tool to Optimize Selection of Head and Neck Cancer Patients for Proton Therapy

“…The main advantages of such a tool would be to decrease delays in treatment initiation and to make efficient use of available resources. It may also allow for physicians to discuss the option for PT with their patients based on reliable estimates of the potential gain, which will thereby enhance shared decision making on a referral for PT, and whether this might be worthwhile [14][15][16][17].…”