Cancer
Association Between Travel Distance to Treatment Facilities and Survival Among Children with Cancer in Louisiana Emma Hymel* Emma Hymel Kendra Ratnapradipa Edward Peters Cheng Zheng Jenna Allison Mei-Chin Hsieh Shinobu Watanabe-Galloway
Background: Treatment for pediatric cancer generally occurs in specialized tertiary care centers found in large urban areas, resulting in a significant travel burden for pediatric cancer patients. The effects of travel burden on pediatric cancer patients has primarily been examined with qualitative studies, and the few existing quantitative studies have observed mixed results.
Methods: We conducted a population-based longitudinal study using data from the Louisiana Tumor Registry. This study included all children with cancer diagnosed at age 0-19 from 2000 to 2020. Multiple imputation with chained equations was used to handle missing data. Travel distance was reported as the distance between patients’ homes and treatment facilities in miles using the great circle distance method. Cox proportional hazards regression models were used to compute the association between distance to treatment (in quartiles) and cancer-specific survival. A directed acyclic graph was used to identify the variables needed to control for confounding.
Results: Our study included 2,720 children with cancer in Louisiana. Overall, 458 (16.84%) of the children died during follow-up and over 15% of the children lived over 100 miles from their treatment facility, with a median distance of 21.58 miles. Travel distance was significantly associated with survival; compared to those living closest to their treatment center, those living furthest from their treatment center were 61% more likely to die from their cancer (95% CI: 1.22-2.11). The effect of travel distance was strongest for children with extracranial solid tumors (Q3 vs. Q1: aHR=2.00, 95% CI: 1.29-3.11; Q4 vs. Q1: aHR=2.40, 95% CI: 1.56-3.68).
Conclusion: In our study, we observed that travel distance was associated with pediatric cancer survival. The effect of distance on survival varied by cancer type. In future studies, we will explore differences in the effect of estimated travel time and accessibility rather than travel distance.