Geospatial access predicts cancer stage at presentation and outcomes for patients with breast cancer in southwest Nigeria: A population‐based study

• Published in: Cancer 2021-05, Vol.127 (9), p.1432-1438
• Main Authors: Knapp, Gregory C., Tansley, Gavin, Olasehinde, Olalekan, Wuraola, Funmilola, Adisa, Adewale, Arowolo, Olukayode, Olawole, M. O., Romanoff, Anya M., Quan, May Lynn, Bouchard‐Fortier, Antoine, Alatise, Olusegun I., Kingham, T. Peter
• Format: Article
• Language: English
• Subjects: access; Adult; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer Care Facilities; Chemotherapy; Databases, Factual; equity; Female; geographic information system (GIS); Geographic Information Systems; Health policy; Health Services Accessibility; Humans; Logistic Models; Middle Aged; Neoplasm Staging; Nigeria; Oncology; Patients; Population studies; Population-based studies; Regression analysis; Retrospective Studies; Socioeconomics; Surgery; Survival; Survival Analysis; Tertiary Care Centers; Time Factors; Travel; Travel time
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.33394

Background The majority of women in Nigeria present with advanced‐stage breast cancer. To address the role of geospatial access, we constructed a geographic information‐system–based model to evaluate the relationship between modeled travel time, stage at presentation, and overall survival among patients with breast cancer in Nigeria. Methods Consecutive patients were identified from a single‐institution, prospective breast cancer database (May 2009‐January 2019). Patients were geographically located, and travel time to the hospital was generated using a cost‐distance model that utilized open‐source data. The relationships between travel time, stage at presentation, and overall survival were evaluated with logistic regression and survival analyses. Models were adjusted for age, level of education, and socioeconomic status. Results From 635 patients, 609 were successfully geographically located. The median age of the cohort was 49 years (interquartile range [IQR], 40‐58 years); 84% presented with ≥stage III disease. Overall, 46.5% underwent surgery; 70.8% received systemic chemotherapy. The median estimated travel time for the cohort was 45 minutes (IQR, 7.9‐79.3 minutes). Patients in the highest travel‐time quintile had a 2.8‐fold increase in the odds of presenting with stage III or IV disease relative to patients in the lowest travel‐time quintile (P = .006). Travel time ≥30 minutes was associated with an increased risk of death (HR, 1.65; P = .004). Conclusions Geospatial access to a tertiary care facility is independently associated with stage at presentation and overall survival among patients with breast cancer in Nigeria. Addressing disparities in access will be essential to ensure the development of an equitable health policy. Geospatial access to cancer care is associated with cancer stage at presentation and overall survival among patients with breast cancer in Nigeria. As the country's breast cancer control system matures, measuring access will be essential to ensure the development of an equitable health policy.