Cervical cancer treatment initiation and survival: The role of residential proximity to cancer care

• Published in: Gynecologic oncology Vol. 160; no. 1; pp. 219 - 226
• Main Authors: Hung, Peiyin, Zahnd, Whitney E., Brandt, Heather M., Adams, Swann A., Wang, Shiyi, Eberth, Jan M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2021
• Subjects: Access; Cervical cancer/oncology; Distance to care; Retrospective cohort study; Survival analysis; Time to treatment initiation; Cervical cancer/oncology; Access; Survival analysis; Retrospective cohort study; Distance to care; Time to treatment initiation
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2020.10.006

To examine the role of driving time to cancer care facilities on days to cancer treatment initiation and cause-specific survival for cervical cancer patients.
A retrospective cohort analysis of patients diagnosed with invasive cervical cancer during 2001–2016, using South Carolina Central Cancer Registry data linked to vital records. Kaplan-Meier survival curves and Cox proportional hazards models were used to examine the association of driving times to both a patient's nearest and actual cancer treatment initiation facility with cause-specific survival and time to treatment initiation.
Of 2518 eligible patients, median cause-specific survival was 49 months (interquartile, 17–116) and time to cancer treatment initiation was 21 days (interquartile, 0–40). Compared to patients living within 15 min of the nearest cancer provider, those living more than 30 min away were less likely to receive initial treatment at teaching hospitals, Joint Commission accredited facilities, and/or Commission on Cancer accredited facilities. After controlling for patient, clinical, and provider characteristics, no significant associations existed between driving times to the nearest cancer provider and survival/time to treatment. When examining driving times to treatment initiation (rather than simply nearest) provider, patients who traveled farther than 30 min to their actual providers had delayed initiation of cancer treatment (hazard ratio, 0.81; 95% confidence interval, 0.73–0.90), including surgery (0.82; 95% CI, 0.72–0.92) and radiotherapy (0.82, 95% CI, 0.72–0.94). Traveling farther than 30 min to the first treating provider was not associated with worse cause-specific survival.
For cervical cancer patients, driving time to chosen treatment providers, but not to the nearest cancer care provider, was associated with prolonged time to treatment initiation. Neither was associated with survival.
•Women living farther from a cancer facility tend to live in higher-poverty areas, and to be treated at rural facilities.•Private insured patients were more likely to live closer to a cancer care facility than their counterparts.•Women living farther from a cancer facility were less likely to be treated at accredited and teaching hospitals.•Driving times to treating providers, but not to the nearest providers, were associated with prolonged treatment initiation.•Driving times to the nearest cancer provider were neither associated with survival nor with time to treatment.