A qualitative study on the impact of long-distance travel for gynecologic cancer care

Mujumdar, Vaidehi; Butler, Timberly R.; Shalowitz, David I.

doi:10.1016/j.gore.2021.100868

Cited by 11 publications

(5 citation statements)

References 10 publications

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“…Qualitative studies examining the role of travel burden and access to care in surgical decision making may help contextualize our understanding of these factors as decision-making factors among rural women electing CPM. Among rural women with gynecologic cancers, for example, one qualitative study found that recommendations from physicians and others were the primary drivers of travel, despite the associated burdens [39]. Studies like this among rural women electing CPM may help identify intervention strategies to reduce guideline non-concordant CPM among this population.…”

Section: Discussionmentioning

confidence: 97%

Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer

Wahlen

Lizarraga

Kahl³

et al. 2023

Cancer Causes Control

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Purpose Despite lack of survival benefit, demand for contralateral prophylactic mastectomy (CPM) to treat unilateral breast cancer remains high. High uptake of CPM has been demonstrated in Midwestern rural women. Greater travel distance for surgical treatment is associated with CPM. Our objective was to examine the relationship between rurality and travel distance to surgery with CPM. Methods Women diagnosed with stages I–III unilateral breast cancer between 2007 and 2017 were identified using the National Cancer Database. Logistic regression was used to model likelihood of CPM based on rurality, proximity to metropolitan centers, and travel distance. A multinomial logistic regression model compared factors associated with CPM with reconstruction versus other surgical options. Results Both rurality (OR 1.10, 95% CI 1.06–1.15 for non-metro/rural vs. metro) and travel distance (OR 1.37, 95% CI 1.33–1.41 for those who traveled 50 + miles vs. < 30 miles) were independently associated with CPM. For women who traveled 30 + miles, odds of receiving CPM were highest for non-metro/rural women (OR 1.33 for 30–49 miles, OR 1.57 for 50 + miles; reference: metro women traveling < 30 miles). Non-metro/rural women who received reconstruction were more likely to undergo CPM regardless of travel distance (ORs 1.11–1.21). Both metro and metro-adjacent women who received reconstruction were more likely to undergo CPM only if they traveled 30 + miles (ORs 1.24–1.30). Conclusion The impact of travel distance on likelihood of CPM varies by patient rurality and receipt of reconstruction. Further research is needed to understand how patient residence, travel burden, and geographic access to comprehensive cancer care services, including reconstruction, influence patient decisions regarding surgery.

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Section: Discussionmentioning

confidence: 97%

Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer

Wahlen

Lizarraga

Kahl³

et al. 2023

Cancer Causes Control

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“…By contrast, we can assume that patients for whom distance was a problem preferred a closer hospital. In a recent qualitative study, Mujumdar et al 28 highlighted that some women with gynaecological malignancies might prefer to be cared at a referral centre despite a longer travel time.…”

Section: Discussionmentioning

confidence: 99%

Are patients living far from hospital at higher risk of late adjuvant chemotherapy for colon cancer?

Vermeulin

Lahbib

Lucas

et al. 2022

Brit J Clinical Pharma

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Aims Late adjuvant chemotherapy (aCT) administration after colectomy (>56 d) is known to be associated with impaired prognosis. We aim to identify risk factors associated with late aCT, especially the travel time between patients' home and hospital. Methods We performed a retrospective monocentre cohort study. Patients included had a colectomy for a stage III or high risk stage II colon cancer between 2009 and 2015 performed at a French university hospital. Risk factors for late aCT were identified using a fractional polynomial logistic regression. Results Ninety‐four patients were included. The risk of late aCT was associated with travel time length, emergent colectomy, the need for scheduled care before aCT, and length of time between colectomy and postoperative multidisciplinary meeting advising aCT. Conclusion Our study suggests that, in patients with colon cancer, factors unrelated to disease severity and complexity could be associated with a higher risk of late aCT.

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“…A qualitative interview study recruited 19 women that traveled an average of 87 miles to receive gynecologic oncology care. The study revealed themes of timing and the need to coordinate a companion as barriers to receiving care and reported that most patients had to utilize personal resources or utilize community programs (similar to Family House at UPMC) in order to participate in non-surgical care away from home [ 32 ]. This study corroborated the perspective of interviewed physicians that social support was essential for patients that had to travel for oncologic care.…”

Section: Discussionmentioning

confidence: 99%

Qualitative Interview Study of Gynecologic Oncologist Utilization of Recommended Same-Day Discharge Following Minimally Invasive Hysterectomy

Bunde

Adambekov

Glikson

et al. 2022

JPM

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Recent investigations have supported the safety and benefits of discharging women on the same day following a minimally invasive hysterectomy (MIH) for both benign and malignant indications. Not all eligible candidates for same-day discharge (SDD) are discharged the same day, and patients undergoing an MIH for malignant indications have decreased the odds of receiving SDD despite established safety. The objective of this study was to use qualitative interviews to explore physician decision making regarding SDD after an MIH for malignant indications. Six qualitative interviews of gynecologic oncologists were analyzed using recurrent theme analysis for distinct themes in physician decision making regarding SDD. Results suggest that physician-perceived barriers to SDD include patient health characteristics, patient social characteristics, and hospital-system factors. Cited factors influencing SDD include patient travel, social support, practice setting (urban vs. rural) and staff comfort with the recommendation. Obstructive sleep apnea and post-surgical oxygenation appear to be a recurring reason for unplanned admission. The utilization of SDD after an MIH in the gynecologic oncology patient population is influenced by patient, physician, and system factors. Addressing the physician’s perceived barriers to SDD and catering recommendations to the gynecologic oncology population may increase utilization.

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A qualitative study on the impact of long-distance travel for gynecologic cancer care

Abstract: Highlights Barriers to travel included time, cost, companionship, navigation, and physical discomfort. Social support was an important facilitator of travel for care. A significant minority of patients preferred in-person visits to telemedicine.

Cited by 11 publications

References 10 publications

Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer

Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer

Are patients living far from hospital at higher risk of late adjuvant chemotherapy for colon cancer?

Qualitative Interview Study of Gynecologic Oncologist Utilization of Recommended Same-Day Discharge Following Minimally Invasive Hysterectomy

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