Distance Traveled to Head and Neck Cancer Provider: A Measure of Socioeconomic Status and Access

Abstract

Objective Improved head and neck cancer survival has been associated with traveling farther distances for treatment, potentially due to patients seeking higher-quality facilities. This study investigates the role of both facility and confounding patient factors on this relationship. Study Design Review of national registry data. Setting National Cancer Database. Subjects and Methods Adults with head and neck cancer diagnosed from 2004 to 2014 were identified. Overall survival was compared among distance-to-facility quartiles via univariate and multivariate survival models. Then, the analysis was stratified by facility and patient factors, and the association between distance and survival was compared among strata. Results Overall survival was worst in the shortest-distance quartile (<5 miles; median survival, 80.7 months; 95% CI, 79.2-82.3), while other distance groups showed similar survival (range, 96.4-104 months). This finding remained in the multivariate model (adjusted hazard ratio vs first distance quartile: 0.88; 95% CI, 0.87-0.89). The association between survival and distance persisted in all subgroups when stratified by facility volume and type (adjusted hazard ratio range, 0.82-0.91), suggesting that facility quality does not fully account for this association. When stratified by income, distance remained statistically associated with survival but with a smaller effect size than that of income. Conclusion The association between distance to treating facility and head and neck cancer survival is limited to patients with worse survival outcomes living within 5 miles of the facility and is not fully explained by measures of facility quality.

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

“…Consistent with our observations, previous studies have shown that reduced access to care, as measured by travel time to treating facility, is related to SES 49,50 . One study found that access to care, as measured by insurance status, was the most important factor associated with racial differences in HNSCC 5‐year survival 31 .…”

Associations between geographic residence and US adolescent and young adult cancer stage and survival

“…22 Other studies have not found an association between rural residence and cancer survival for ovarian 23 and head and neck cancer. 24 Survival results from NCDB studies for residential distance to the diagnosis reporting hospital are mostly in contrast to our results, with the exception of CNS tumors, with studies showing that longer distance is associated with improved survival outcomes for head and neck, 25,26 gastrointestinal, 27 rectal, 28 prostate, 29 and gallbladder, 30 but not ovarian 31 cancers. Superior survival for some cancers may possibly be explained by treatment at an academic medical center or a high-volume center.…”

Disparities in Mortality from Larynx Cancer: Implications for Reducing Racial Differences

“…It is also well established that health outcome disparities between patients of different races are largely related to a myriad of socioeconomic factors such as marital status, income, education level, insurance status, and distance to treatment facility. 6,[12][13][14][15][16][17][18] In a recent study by Shin et al that controlled for various factors, race was still found to independently predict overall mortality (OM) of laryngeal squamous cell carcinoma (LSCC) in the United States. 19 Historically, Black patients have had lower survival in the United Sates.…”