Relationship Between Travel Distance and Utilization of Breast Cancer Treatment in Rural Northern Michigan

Abstract

THE ELECTORAL MAP OF 2000-WITH ITS COASTAL BLUE EDGES AND POINtillist urban centers set against great swaths of red-told many political and economic stories. Attitudes toward rural life often reveal a complex mixture of affection and disdain, ideas about neighborliness and isolation, simplicity and provincialism. In his recent essay, "One Nation, Slightly Divisible," David Brooks argues that the differences between rural and urban America may be merely superficial, exemplified in consumer preferences such as Wal-Mart vs Pottery Barn. 1 Although I agree with his assertion that the two locales possess unique "sensibilities," there are important differences in rural vs urban health care. While 20% of Americans live in rural areas, only 9% of the nation's physicians practice there. Poverty-a principal health risk factor in any geographic locale-is more prevalent in rural areas and is often related to increased rates of chronic disease and greater numbers of uninsured citizens. 2 Rural residents have fewer physicians and nurses per capita and increased transportation barriers; they visit a physician less often and later in the course of their illness than do urban residents. 2 This issue of MSJAMA explores the question of whether there are two US health care delivery systems, one urban and one rural. Differences between urban and rural health care exist on a continuum defined by many variables. Susan Blumenthal and Jessica Kagen provide an epidemiologic background in which to consider important differences and markers between rural and urban health. Hilda Heady explores some of the monetary inequities embodied in rural vs urban reimbursement policies. Terry Meden and colleagues describe how distance from a tertiary care center may be related to decisions about mastectomy for rural women with stages I and II breast cancer. Although Roe vs Wade made abortion legal in the United States, this right may be moot in many rural settings. Trude Bennett explores some of these barriers to prenatal care, family planning, surgical contraception, and other reproductive health care services in rural areas. To address the chronic geographic maldistribution of physicians, Howard Rabinowitz and Nina Paynter outline the constructs that inform medical students' decision to become generalists or specialists and correlatively to practice in a rural vs an urban setting. These inequities in rural vs urban health care delivery are based in structural, economic, and cultural differences. Through increased awareness, research, education, and preventive public health measures, congress, and ultimately communities and the health care providers who serve them, may begin to lessen the degrees of difference.

Perceptions of Shared Decision Making and Decision Aids Among Rural Primary Care Clinicians

“…For example, women with stage I or II breast cancer who lived at greater distances from a radiation oncology facility were more likely to undergo a mastectomy than more limited surgery plus radiation therapy, which would require additional travel burden and associated costs. 32 Our results are consistent with other research regarding adoption of digital tools in clinical practice. Electronic health record adoption is slowed in practices where the benefits confer on others while the costs are incurred by the practice itself.…”

Disparities in clinical trial participation among older adult Medicare beneficiaries with hematologic malignancies from 2006 to 2019: A SEER–Medicare analysis

“…Consistent with prior research, 47 , 64 , 76 , 77 we also found that patients living farther from NCI centers and those with lower socioeconomic status were less likely to participate in CTs. A recent study by Casey et al.…”

“…Consistent with prior research, 47,64,76,77 we also found that patients living farther from NCI centers and those with lower socioeconomic status were less likely to participate in CTs. A recent study by Casey et al 16 Support Center (CTSC), which works to connect patients with trial opportunities and offers resources for travel and insurance navigation.…”

Health care‐related time costs in patients with metastatic breast cancer

“…The greatest component of patient ambulatory care time was not time with the oncologist, but rather time spent traveling. Previous literature has reported associations between increased distance and time traveled to care for patients with more advanced disease stages 12‐18 . However, our findings demonstrated a considerably higher travel time of 155 minutes compared with that reported by Yabroff et al, who reported average travel times of 35‐39 minutes 4 .…”