Is Distance to Provider a Barrier to Care for Medicaid Patients With Breast, Colorectal, or Lung Cancer?

Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.

doi:10.1111/j.1748-0361.2011.00371.x

Cited by 83 publications

(68 citation statements)

References 24 publications

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“…The distinctly higher travel burden observed among rural patients is consistent with previous studies 4 , although the present findings further identify a socioeconomic difference among these populations. The most deprived quintile of rural patients had a median travel time of 6 hours: 14 times that of the most deprived urban patients, and 33 times that of the most affluent urban patients.…”

supporting

confidence: 93%

“…The most deprived quintile of rural patients had a median travel time of 6 hours: 14 times that of the most deprived urban patients, and 33 times that of the most affluent urban patients. While this has been observed, albeit to a lesser degree, in previous studies 4 , the authors are yet to identify any similar findings along dual socioeconomic and spatial axes in the literature. However, it must be noted that the observed degrees of difference in this study may be amplified by BC's large size and remote northern half, a geographically unique configuration when compared to other studies of access to cancer treatment.…”

supporting

confidence: 52%

“…This results in a geographical inequity, such that individuals living farther from a cancer treatment center experience a greater travel burden in order to attend their treatment, particularly those living in rural and remote areas 3 . This travel burden has been shown to have significant effects on patients' tumor stage and grade at the time of diagnosis [4][5][6][7][8][9] , decisions concerning treatment 3,[10][11][12][13] , and survival…”

mentioning

confidence: 99%

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Socioeconomic disparities in head and neck cancer patients’ access to cancer treatment centers

Walker

Schuurman

Auluck³

et al. 2017

Rural Remote Health

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Introduction: Both socioeconomic status and travel time to cancer treatment have been associated with treatment choice and patient outcomes. An improved understanding of the relationship between these two dimensions of access may enable cancer control experts to better target patients with poor access, particularly in isolated suburban and rural communities. Methods: Using geographical information systems, head and neck cancer patients across British Columbia, Canada from 1981 to 2009, were mapped and their travel times to the nearest treatment center at their time of diagnosis were modelled. Patients' travel times were analysed by urban, suburban, and rural neighborhood types and an index of multiple socioeconomic deprivation was used to assess the role of socioeconomic status in patients' spatial access. Results: Significant associations between socioeconomic deprivation and spatial access to treatment were identified, with the most deprived quintiles of patients experiencing nearly twice the travel time as the least deprived quintile. The sharpest disparities were observed among the most deprived patient populations in suburban and rural areas. However, the establishment of new treatment centers has decreased overall travel times by 28% in recent decades. Conclusions: Residence in a neighborhood with high socioeconomic deprivation is strongly associated with head and neck cancer patients' spatial access to cancer treatment centers. Patients residing in the most socioeconomically deprived neighborhoods consistently have longer travel times in urban, suburban, and rural communities in the study area.Key words: cancer treatment, socioeconomic status, deprivation, head and neck cancers, spatial access, geographic information systems, Canada.© BB Walker, N Schuurman, A Auluck, SA Lear, M Rosin 2017. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2 IntroductionWith an estimated 525 000 new cases in 2012, head and neck cancers are the eighth most common non-melanoma cancers globally 1. This number is expected to grow significantly in the coming decades, resulting in increased demand for treatment 2 .To maximize efficiency, comprehensive cancer treatment facilities are most commonly located in areas where they service the largest proportion of the patient population, generally in large urban centers. This results in a geographical inequity, such that individuals living farther from a cancer treatment center experience a greater travel burden in order to attend their treatment, particularly those living in rural and remote areas , and survival 14. The time required for patients to travel from the home to a cancer treatment center is therefore an important factor throughout the continuum of care, and may inform more efficient and equitable cancer control programs and policy.The travel time required for an individual to reach a treatment center provides a quantitative measure of access 15 . However, an individual's access to a health service may also be measured as the ...

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confidence: 93%

supporting

confidence: 52%

mentioning

confidence: 99%

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Socioeconomic disparities in head and neck cancer patients’ access to cancer treatment centers

Walker

Schuurman

Auluck³

et al. 2017

Rural Remote Health

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“…Travel can be of particular importance for socioeconomically disadvantaged persons, because the time costs associated with care can strain limited resources. Also, lower provider accessibility or transportation barriers can result in longer travel times for lowincome individuals [1]. It is also reasonable to surmise that differences in the stage at diagnosis, for example, in the Breslow thickness for melanoma patients, could translate into differences in overall survival, even if these studies had not provided survival data [9].…”

Section: Cmementioning

confidence: 99%

Distance as a Barrier to Cancer Diagnosis and Treatment: Review of the Literature

et al. 2015

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The burden of travel from a patient's residence to health care providers is an important issue that can influence access to diagnosis and treatment of cancer. Although several studies have shown that the travel burden can result in delays in diagnosis and treatment of many common cancers, its role appears underestimated in the treatment of patients in clinical practice. Therefore, we performed a review of the published data on the role of travel burden influencing four items: delay of diagnosis, adequate treatment of cancer, outcome, and quality of life of cancer patients. Forty‐seven studies published up to December 2014 were initially identified. Twenty studies were excluded because they did not regard specifically the four items of our review. Twenty‐seven studies formed the basis of our study and involved 716,153 patients. The associations between travel burden and (a) cancer stage at diagnosis (12 studies), (b) appropriate treatment (8 studies), (c) outcome (4 studies), and (d) quality of life (1 study) are reported. In addition, in two studies, the relation between travel burden and compliance with treatment was examined. The results of our review show that increasing travel requirements are associated with more advanced disease at diagnosis, inappropriate treatment, a worse prognosis, and a worse quality of life. These results suggest that clinical oncologists should remember the specific travel burden problem for cancer patients, who often need health care services every week or every month for many years. Implications for Practice: The influence of travel burden on cancer patients has been previously studied, but this is the first comprehensive review of the available literature. This review shows that travel burden negatively influences stage at diagnosis, appropriate treatment, outcome, and quality of life in cancer patients. The results demonstrate that clinical oncologists should keep in mind the specific travel burden problem for cancer patients who often need health care services every week or every month for many years.

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“…Transportation difficulty can have a significant effect on utilization of health services. A large study of cancer patients in Washington state revealed later stage at diagnosis and delayed treatment for those living in rural areas and reporting transportation difficulty (Scoggins et al, 2012). In addition, many rural areas are designated as Medically Underserved Areas or Health Professional…”

Section: Adolescencementioning

confidence: 99%

Predictors of lifestyle behaviors, trust of health care provider, and utilization of health services among adolescents living in a rural area.

Hardin

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Is Distance to Provider a Barrier to Care for Medicaid Patients With Breast, Colorectal, or Lung Cancer?

Cited by 83 publications

References 24 publications

Socioeconomic disparities in head and neck cancer patients’ access to cancer treatment centers

Socioeconomic disparities in head and neck cancer patients’ access to cancer treatment centers

Distance as a Barrier to Cancer Diagnosis and Treatment: Review of the Literature

Predictors of lifestyle behaviors, trust of health care provider, and utilization of health services among adolescents living in a rural area.

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