Travel distance: Impact on stage of presentation and treatment choices in head and neck cancer

• Published in: American journal of otolaryngology 2018-09, Vol.39 (5), p.575-581
• Main Authors: Ringstrom, Mark J., Christian, Jay, Bush, Matthew L., Levy, Jeffrey E., Huang, Bin, Gal, T.J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cancer; Cancer therapies; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemotherapy; Clinical Decision-Making; Demographic variables; Demographics; Female; Head & neck cancer; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Health care access; Health care facilities; Health Services Accessibility; Humans; Kentucky; Logistic Models; Male; Mammography; Medicaid; Medicare; Middle Aged; Mortality; Multivariate analysis; Neoplasm Staging; Oral cavity; Otolaryngology; Patient Selection; Patients; Postal codes; Radiation; Radiation therapy; Retrospective Studies; Rural areas; Squamous cell carcinoma; Surgery; Therapy; Travel; Tumors
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2018.06.020

The objective was to examine the impact of travel distance on stage of presentation and treatment choices in head and neck squamous cell carcinoma in the rural setting. 6029 cases diagnosed from 2002 to 2011 were obtained from the state cancer registry. Travel time was calculated to the nearest academic medical centers, otolaryngologist, and radiation treatment facilities. Multivariate logistic regression was used to examine the association of travel time with stage of presentation as well as the likelihood of appropriate therapy after adjustment for other demographic variables. Patients in the highest quartile for travel distance to academic centers were 33% more likely to present with early stage disease (p = 0.02), and 42% more likely to receive appropriate surgical therapy for oral cavity cancer. Patients were 70% more likely to receive appropriate surgery if they were farthest from the nearest radiation center (p = 0.03). Proximity to otolaryngology care was not significant. Increased travel distance to academic medical centers is associated with increased likelihood of proper therapy for surgically treated tumors of the head and neck. Impact on these findings on improvements in access to care is discussed.