Association Between Geographic Access to Cancer Care and Receipt of Radiation Therapy for Rectal Cancer

Abstract

Purpose Trimodality therapy (chemoradiation and surgery) is standard of care for Stage II/III rectal cancer but nearly one third of patients do not receive radiation therapy (RT). We examined the relationship between density of radiation oncologist and travel distance to receipt of RT. Materials/Methods A retrospective study based on the National Cancer Data Base identified 26,845 patients aged 18–80 with Stage II/III rectal cancer diagnosed between 2007–2010. Radiation oncologists were identified through Physician Compare Dataset. Generalized Estimating Equations clustering by Hospital Service Area was utilized to examine the association between geographic access and receipt of RT, controlling for patient sociodemographic and clinical characteristics. Results 70% of patients received RT within 180 days of diagnosis or within 90 days of surgery. Compared to travel distance <12.5 miles, patients diagnosed at reporting facility who traveled ≥50 miles had a decreased likelihood of receipt of RT (50–249 miles: adjusted Odds Ratio [aOR] 0.75, p<.001; ≥250 miles: aOR 0.46, p=.002), all else being equal. Density level of radiation oncologists was not significantly associated with receipt of RT. Patients who were female, nonwhites, ≥50 years, and with comorbidities were less likely to receive RT (p<.05). Patients who were uninsured but self-paid for their medical services, initially diagnosed elsewhere but treated at reporting facility, and resided in Midwest had increased likelihood of receipt of RT (p<.05). Conclusions Increased travel burden was associated with a decreased likelihood of receiving RT for stage II/III rectal cancer patients when all else being equal, but radiation oncologist density was not. Further research in geographic access and establishing transportation assistance programs, or lodging services for patients with unmet need may help decrease geographic barriers and improve the quality of rectal cancer care.

Socioeconomic factors affect the selection of proton radiation therapy for children

“…We also found that patients treated with proton therapy traveled significantly longer distances than those treated with photon therapy. 22 The distance to radiation facilities has been shown to affect the selection of treatments, that include radiotherapy (eg, breast conservation therapy and multimodality therapy), [31][32][33][34][35] and our analysis demonstrated that patients treated with proton therapy traveled significantly longer distances than those treated with photon therapy to access the limited number of proton therapy centers in the United States. Our multivariate analysis suggests that socioeconomic factors, including insurance and neighborhood income and education, are significantly associated with differences in the receipt of proton therapy versus photon therapy.…”

Why is neoadjuvant chemoradiation therapy underused for locally advanced rectal cancer?

“…Thus, geographic access should be considered as a significant variable associated with the receipt of treatment for LARC patients, whereas the density level of radiation oncologists cannot. Moreover, patients with nonprivate insurance who lived in low-density oncologist areas were less likely to receive the standard treatment [5,6]. socioeconomic status, age, and comorbidities.…”

Impact of travel distance to the treatment facility on overall mortality in US patients with prostate cancer

“…5 For example, increased travel distance was associated with an increasing likelihood of high-risk prostate 6 and colon cancer 7 at diagnosis. 9 Conversely, a recent report by Wasif et al, which focused exclusively on patients who underwent surgery, demonstrated that longer travel distance is associated with better long-term cancer outcomes in colon, esophageal, liver, and pancreatic malignancies. 9 Conversely, a recent report by Wasif et al, which focused exclusively on patients who underwent surgery, demonstrated that longer travel distance is associated with better long-term cancer outcomes in colon, esophageal, liver, and pancreatic malignancies.…”