BACKGROUND
Patients who travel a long distance (≥50 miles) for cancer
care have improved outcomes. However, to the authors’ knowledge, the
prevalence of long travel distances for treatment by patients with head and
neck squamous cell carcinoma (HNSCC), and the effect of travel distance on
overall survival (OS), remains unknown.
METHODS
The authors used the National Cancer Data base from 2004 through 2013
to identify patients with HNSCC undergoing definitive treatment. Travel
distance for treatment was categorized as short (<12.5 miles),
intermediate (12.5-49.9 miles), and long (50-249.9 miles). The primary
outcome, OS, was evaluated using Cox shared-frailty modeling. A secondary
outcome, factors associated with intermediate and long travel distances, was
evaluated using multivariable hierarchical logistic regression.
RESULTS
Among 118,000 patients with HNSCC, 62,753 (53.2%), 40,644
(34.4%), and 14,603 (12.4%) patients, respectively, traveled
short, intermediate, and long distances for treatment. After adjusting for
relevant covariates, long travel distance was associated with treatment at
academic and high-volume centers. Patients of black race, of Hispanic
ethnicity, with Medicaid insurance, and who were treated with nonsurgical
treatment were less likely to travel long distances for treatment
(P<.001). Traveling a long distance for
treatment was associated with improved OS on multivariable analysis
(adjusted hazard ratio, 0.93; 95% confidence interval, 0.89-0.96)
compared with a short distance.
CONCLUSIONS
Traveling a long distance for HNSCC treatment is associated with
improved survival, especially for patients receiving nonsurgical management.
Racial and ethnic disparities in travel for HNSCC treatment exist. As
regionalization of care continues, future work should identify and address
reasons for racial and ethnic disparities in travel that may prevent access
to care at high-volume facilities.