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Showing content from https://pubmed.ncbi.nlm.nih.gov/24516014/ below:

Association between travel distance and metastatic disease at diagnosis among patients with colon cancer

. 2014 Mar 20;32(9):942-8. doi: 10.1200/JCO.2013.52.3845. Epub 2014 Feb 10. Association between travel distance and metastatic disease at diagnosis among patients with colon cancer

Affiliations

Affiliation

¹ All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.

PMID: 24516014
PMCID: PMC4359212
DOI: 10.1200/JCO.2013.52.3845

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Association between travel distance and metastatic disease at diagnosis among patients with colon cancer

Nader N Massarweh et al. J Clin Oncol. 2014.

. 2014 Mar 20;32(9):942-8. doi: 10.1200/JCO.2013.52.3845. Epub 2014 Feb 10. Affiliation

¹ All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.

PMID: 24516014
PMCID: PMC4359212
DOI: 10.1200/JCO.2013.52.3845

Item in Clipboard

Abstract

Purpose: Health care access and advanced cancer stage are associated with oncologic outcomes for numerous common cancers. However, the impact of patient travel distance to health care on stage at diagnosis has not been well characterized.

Methods: This study used a historical cohort of patients with colon cancer in the National Cancer Data Base from 2003 through 2010. The primary outcome, stage at diagnosis, was evaluated using hierarchical regression modeling. A secondary outcome was time to receipt of initial therapy that was evaluated using Cox shared frailty modeling.

Results: Among 296,474 patients with colon cancer (mean age, 68 ± 13.6 years; 47.6% male; 78.5% white), 3.9% traveled ≥ 50 miles to the diagnosing facility. Fewer black patients, patients with higher income, and patients with lower education traveled longer distances (trend test P < .001 for all). Patients traveling ≥ 50 miles were more likely to present with metastatic disease compared with those traveling less than 12.5 miles (odds ratio [OR], 1.18; 95% CI, 1.12 to 1.24) or 12.5 to 49.9 miles (OR, 1.18; 95% CI, 1.12 to 1.24). In sensitivity analyses, the association was robust to alternate methods of modeling travel distance (quintile stratification or continuous). Travel distance ≥ 50 miles was also associated with a higher likelihood of earlier initiation of therapy compared with travel distance of less than 12.5 miles (hazard ratio [HR], 1.10; 95% CI, 1.08 to 1.13) or 12.5 to 49.9 miles (HR, 1.11; 95% CI, 1.08 to 1.13).

Conclusion: Advanced colon cancer stage at diagnosis is associated with patient travel distance to health care, which may be a barrier to early cancer screening. Health care reform efforts designed to address only insurance coverage may not mitigate disparities based on difficulties accessing cancer care.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures
Fig 1.

Flow chart of cohort inclusion/exclusion…

Fig 1.

Flow chart of cohort inclusion/exclusion criteria. Values on the left side of the…

Fig 1.

Flow chart of cohort inclusion/exclusion criteria. Values on the left side of the diagram indicate No. of patients excluded. Values on right side indicate No. of patients included.

Fig 2.

Forest plot of factors associated…

Fig 2.

Forest plot of factors associated with stage IV disease at presentation. Income represents…

Fig 2.

Forest plot of factors associated with stage IV disease at presentation. Income represents that a patient's area of residence (on basis of Census 2000 data) had a median household income ≥ $46,000 or < $46,000. Education represents that a patient's area of residence (on basis of Census 2000 data) had ≥ 29% or < 29% of adults who did not attain a high school education. M− represents a lower likelihood of metastatic disease. M+ represents a greater likelihood of metastatic disease. LCL, lower confidence limit; OR, odds ratio; UCL, upper confidence limit.

Fig 3.

Unadjusted time to receipt of…

Fig 3.

Unadjusted time to receipt of initial therapy among patients with (A) any stage…

Fig 3.

Unadjusted time to receipt of initial therapy among patients with (A) any stage disease and (B) stage IV disease.