Increased Travel Burden Could Reduce Prospect of Radiation Treatment

Travel distance to the site of the radiation clinic can significantly impact the likelihood of a patient with rectal cancer receiving care, a new study published in the International Journal of Radiation Oncology Biology Physics.

The study retrospectively analyzed records from the National Cancer Data Base on 26,845 patients, 18 to 80 years of age, who were diagnosed with stage II/III rectal cancer between 2007 and 2010. The study found that nearly 70% of patients received radiation therapy (RT) within 180 days of diagnosis or 90 days of surgery. There was a definite correlation between travel distance and the likelihood of receiving RT—those who travelled <12.5 miles were more likely than those who had to travel a distance ≥50 miles (50-249 miles, adjusted odds ratio [OR], 0.75; P < .001; and ≥250 miles, adjusted OR, 0.46; P =.002), the study suggests.

A key influencing factor was whether patients were diagnosed and surgically treated at the same facility. If those who were diagnosed and received surgical treatment at the same facility traveled ≥50 miles, they were less likely to receive RT than those traveling <12.5 miles. However, if surgical care and diagnosis happened at different facilities, travel distance did not seem to impact receiving RT.

“Travel burden clearly creates a barrier to radiation therapy access for rectal cancer patients, but this barrier is far from absolute,” said lead author Chun Chieh Lin, PhD, MBA, director of health services research at the American Cancer Society, in a statement. “When patients seek a referral and travel to a different location for their treatment than the facility where they were diagnosed, they are more likely to be treated and to follow through with their treatment. In this sense, patients’ treatment intentions seem to mediate the influence of factors such as travel burden and physician availability.”

Surprisingly, the density of radiation oncologists was not significantly associated with the patients receiving RT, the study reports. According to the study, 28% of patients lived in hospital service areas without a radiation oncologist and had to travel to receive RT at an NCI-designated or comprehensive academic facility. However, this did not seem a detriment to receiving radiation, the study found.

Some other factors that reduced the probability of the patient receiving RT included being female, nonwhite, older than 50 years of age, and comorbidities.

Reference

Lin CC, Bruinooge SS, Kirkwood MK, et al. Association between geographic access to cancer care and receipt of radiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2016;94(4):719-728. doi:http://dx.doi.org/10.1016/j.ijrobp.2015.12.012.