Travel time to provider is associated with advanced stage at diagnosis among low income head and neck squamous cell carcinoma patients in North Carolina

Abstract

Objective: There is considerable variation in the travel required for a patient with head and neck squamous cell carcinoma (HNSCC) to receive a diagnosis. The impact of this travel on the late diagnosis of cancer remains unexamined, even though presenting stage is the strongest predictor of mortality. Our aim is to determine whether travel time affects HNSCC stage at diagnosis independently of other risk factors, and whether this association is affected by socioeconomic status. Materials and Methods: Cases were obtained from the CHANCE database, a population-based case-control study in North Carolina (n=808). The mean age was 59.6 and 72% were male. Stage at diagnosis was categorized as early (T1-T2) or advanced (T3-T4) T stage and the presence or absence of nodal metastasis. Multivariate logistic regression models were used to estimate odds ratios for stage-at-diagnosis based on travel time, after adjustment for variables including demographics, income, insurance status, alcohol, and tobacco use.

Head and Neck Cancer Survival Disparities by Race and Rural–Urban Context

“…Although the impacts of race and rural-urban context in HNC survival have been addressed separately, there has not been adequate research into the combined effect of these factors (10)(11)(12). We aimed to examine the relationship between race and residential rural-urban context and its impact on overall survival in patients with HNC.…”

Targets for improving disparate head and neck cancer outcomes in the low‐income population

“… 48 Farquhara et al, evaluated the effect of travel time and socioeconomic status on stage of diagnosis in head and neck cancer patients in North Carolina. 49 Driving time was independently associated with an advanced T‐stage at diagnosis for low‐income HNSCC patients (OR 1.97 for each hour driven (95% CI 1.36–2.87) after adjusting for other of other covariates such as medical insurance, indicators of socioeconomic status, and rural location. An inverse relationship between travel distance and outcome was found in two studies, showing that larger travel distance was associated with lower 90‐day mortality post‐treatment.…”

“…Travel distance may disproportionately affect HNSCC patients, who frequently have a low socioeconomic status and can lack resources for transportation 48 . Farquhara et al, evaluated the effect of travel time and socioeconomic status on stage of diagnosis in head and neck cancer patients in North Carolina 49 . Driving time was independently associated with an advanced T‐stage at diagnosis for low‐income HNSCC patients (OR 1.97 for each hour driven (95% CI 1.36–2.87) after adjusting for other of other covariates such as medical insurance, indicators of socioeconomic status, and rural location.…”

Socioeconomic status, access to care, risk factor patterns, and stage at diagnosis for head and neck cancer among black and white patients

“…This discrepancy may be associated with the more frequent presentation at advanced stages (III/IV) for black patients compared to white patients 5–8 . The presentation of advanced HNSCC has also been shown to be influenced by socioeconomic status (SES), 9–12 access to medical care, 13,14 behavioral risk factors such as tobacco and alcohol use, 15–19 human papillomavirus (HPV), 20–22 and access to and use of dental care 23–27 . Furthermore, there is ample evidence that factors associated with advanced cancer presentation interact and that their interaction may vary according to race 16,28,29 .…”

“…Notably, previous studies addressing HNSCC risk have largely examined contributing factors individually as independent risk factors but have not accounted for the interdependence of different factors. For example, analyses of access to medical care typically have not accounted for SES, which has been shown to influence patients' timely interaction with medical care, 14 or behavioral risk factors (e.g., tobacco, alcohol, and oral health) which are thought to interact with SES 16 . Overall, the existing literature provides associative data regarding the influence of individual components of SES, access, and behavioral risk factors on HNSCC and stage but fails to provide a more comprehensive and holistic assessment of how these factors may interact jointly to impact the HNSCC stage.…”