Travel distance and its interaction with patient and hospital factors in pancreas cancer care

Siegel, Julie B.; Engelhardt, K; Hornor, Melissa A.; Morgan, Katherine A.; Lancaster, William

doi:10.1016/j.amjsurg.2020.08.023

Cited by 15 publications

(15 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Distance and access to tertiary health settings have been shown to contribute to later presentation and more advanced disease in Indigenous populations, along with health professionals in rural and remote settings being trained as generalists [ 18 , 50 , 51 ]. Not only is remoteness a likely impediment to regular, and timely, access to health care and poor overall cancer survival [ 52 ], but cultural marginalisation and access to culturally safe and responsive healthcare is also a compounding factor contributing to delayed disease presentations or delay in timely treatment [ 16 , 53 ]. Whilst underrepresentation of Indigenous status within registries remains an area of global concern [ 12 , 20 ], in the NT, there is good ascertainment of Indigenous status, as evidenced by no missing data in the NTCR data analysed in this study.…”

Section: Discussionmentioning

confidence: 99%

Young-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples

Shepherdson

Leemaqz

Singh

et al. 2022

Cancers

View full text Add to dashboard Cite

Background and Aims: A concerning rise in incidence of young-onset cancers globally led to the examination of trends in incidence and survival of gastrointestinal (GI) adenocarcinomas in the Northern Territory (NT), Australia, over a 28-year period, with a special emphasis on Indigenous peoples. Methods: This cross-sectional analysis of a prospective longitudinal database, NT Cancer Registry (1990–2017), includes all reported cases of GI (oesophagus, gastric, small intestinal, pancreas, colon, and rectum) adenocarcinomas. Poisson regression was used to estimate incidence ratio ratios, and survival was modelled using Cox proportional hazard models separately for people aged 18–50 years and >50 years. Results: A total of 1608 cases of GI adenocarcinoma were recorded during the time of the study. While the overall incidence in people 18–50 years remained unchanged over this time (p = 0.51), the rate in individuals aged >50 years decreased (IRR = 0.65 (95% CI 0.56–0.75; p < 0.0001)). Incidence rates were significantly less in females >50 years (IRR = 0.67 95% CI 0.59–0.75; p < 0.0001), and their survival was significantly better (HR = 0.84 (95%CI 0.72–0.98; p < 0.03)) compared to males. Overall survival across all GI subsites improved in both age cohorts, especially between 2010 and 2017 (HR = 0.45 (95%CI 0.29–0.72; p < 0.0007) and HR = 0.64 (95%CI 0.52–0.78; p < 0.0001), respectively) compared to 1990–1999, driven by an improvement in survival in colonic adenocarcinoma alone, as the survival remained unchanged in other GI subsites. The incidence was significantly lower in Indigenous patients compared to non-Indigenous patients, in both age cohorts (18–50 years IRR = 0.68 95% CI 0.51–0.91; p < 0.009 and >50 years IRR = 0.48 95% CI 0.40–0.57; p < 0.0001). However, Indigenous patients had worse survival rates (18–50 years HR = 2.06 95% CI 1.36–3.11; p < 0.0007 and >50 years HR = 1.66 95% CI 1.32–2.08; p < 0.0001). Conclusions: There is a trend towards an increased incidence of young-onset GI adenocarcinomas in the NT. Young Indigenous patients have lower incidence but worse survival across all GI subsites, highlighting significant health inequities in life expectancy. Targeted, culturally safe Indigenous community-focussed programs are needed for early detection and patient-centred management of GI adenocarcinomas.

show abstract

Section: Discussionmentioning

confidence: 99%

Young-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples

Shepherdson

Leemaqz

Singh

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…Third, regionalized centers of excellence are often the nexus for highly specialized cancer care, requiring some patients to travel far distances and spend significant time traveling to access necessary care. 15,16 Fourth, cancer care requires frequent clinical encounters for intensive treatments, resulting in many opportunities for transportation insecurity to impact patients' ability to access care, and compounding financial and practical barriers to accessing care. As a result, patients may miss, delay, or change their care plans.…”

Section: Introductionmentioning

confidence: 99%

A Survey of the National Comprehensive Cancer Network on Approaches Toward Addressing Patients’ Transportation Insecurity

Chaiyachati

Krause²,

Sugalski³

et al. 2023

Journal of the National Comprehensive Cancer Network

View full text Add to dashboard Cite

Background: Addressing patients’ social determinants of health is a national priority for cancer treatment centers. Transportation insecurity is one major challenge for patients undergoing active cancer treatment, and missing treatments can result in worse cancer treatment outcomes, including worse morbidity and mortality. How cancer treatment centers are addressing transportation insecurity is understudied. Methods: In January and February 2022, the NCCN Best Practices Committee conducted a survey of NCCN’s 31 Member Institutions (currently 32 member institutions as of April 2022) to assess how centers were addressing patient transportation insecurity: how they screen for transportation insecurity, coordinate transportation, and fund transportation initiatives, and their plans to address transportation insecurity in the future. Results: A total of 25 of 31 (81%) NCCN Member Institutions responded to the survey, of which 24 (96%) reported supporting the transportation needs of their patients through screening, coordinating, and/or funding transportation. Patients’ transportation needs were most often identified by social workers (96%), clinicians (83%), or patients self-declaring their needs (79%). Few centers (33%) used routine screening approaches (eg, universal screening of social risk factors) to systematically identify transportation needs, and 54% used the support of technology platforms or a vendor to coordinate transportation. Transportation was predominantly funded via some combination of philanthropy (88%), grants (63%), internal dollars (63%), and reimbursement from insurance companies (58%). Over the next 12 months, many centers were either going to continue their current transportation programs in their current state (60%) or expand existing programs (32%). Conclusions: Many NCCN Member Institutions are addressing the transportation needs of their patients. Current efforts are heterogeneous. Few centers have systematic, routine screening approaches, and funding relies on philanthropy more so than institutional dollars or reimbursement from insurers. Opportunities exist to establish more structured, scalable, and sustainable programs for patients’ transportation needs.

show abstract

“…Since HTx centers (HTC) are able to provide higher standard of care than other facilities, the distance between the patient residency and HTC could negatively affect patient outcome. Although the impact of distance traveled to receive medical care is still controversial, it has been largely reported that living at close proximity to specialized institutions seems to confer a positive impact on outcome, especially for those patients requiring primary and onco‐hematologic care 4–8 . However, for patients receiving organ transplantation, the conclusions are less straightforward, due to the scarcity of studies investigating this issue 9–11 …”

Section: Introductionmentioning

confidence: 99%

“…distance traveled to receive medical care is still controversial, it has been largely reported that living at close proximity to specialized institutions seems to confer a positive impact on outcome, especially for those patients requiring primary and onco-hematologic care. [4][5][6][7][8] However, for patients receiving organ transplantation, the conclusions are less straightforward, due to the scarcity of studies investigating this issue. [9][10][11] The aim of this study was to examine the relationship between patient residency distance from HTC and outcomes after HTx.…”

mentioning

confidence: 99%

The impact of the distance between patient residency and heart transplant center on outcomes after heart transplantation

Lechiancole¹,

Ferrara

Sponga

et al. 2023

Clinical Transplantation

View full text Add to dashboard Cite

Introduction Heart transplant (HTx) recipients require continuous monitoring and care in order to prevent and treat possible complications related to the graft function or to the immunosuppressive treatment promptly. Since heart transplantation centers (HTC) are more experienced in managing HTx recipients than other healthcare facilities, the distance between patient residency and HTC could negatively affect the outcomes. Methods Data of patients discharged after receiving HTx between 2000 and 2021, collected into our institutional database, were retrospectively analyzed. The population was divided into three groups: A (n = 180), B (n = 157), and C (n = 134), according to the distance tertiles between patient residency and HTC. The primary end‐point was survival, secondary end‐points were incidences of complications. Results Recipient and donor characteristics did not differ between the three groups. Survival at 10 years was 66 ± 4%, 66 ± 4%, and 65 ± 5%, respectively, for groups A, B, and C (p = .34). Immunosuppressive regimen and rate of complications did not differ between groups. However, the rates of outpatient visits and of hospitalization performed at HTC were higher in group A than others. Conclusion Distance from the HTC does not represent a barrier to a successful outcome for HTx recipients, as long as regular and continuous follow‐up is provided.

show abstract

Travel distance and its interaction with patient and hospital factors in pancreas cancer care

Cited by 15 publications

References 19 publications

Young-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples

Young-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples

A Survey of the National Comprehensive Cancer Network on Approaches Toward Addressing Patients’ Transportation Insecurity

The impact of the distance between patient residency and heart transplant center on outcomes after heart transplantation

Contact Info

Product

Resources

About