Geographic access to cancer care: a disparity and a solution

BACKGROUND The rising cancer incidence in developing countries outpaces easy access to care. Time and effort spent on travel for care is a burden to patients and detracts from patient centredness, efficiency, and equitability. In Trinidad and Tobago, significant distress was observed among patients who made long journeys to the single public cancer clinic. The journey time among non-radiotherapy patients was measured. METHODS Over 19 weekdays in June 2007, the study assessed estimated travel time per visit (ETT), reason for visit for care, and number of visits per patient during their treatment course up to the time of study, and compared the findings with ETT to nearest centres for the US population. RESULTS 1447 episodes of care utilised 5296 h of patient travel time. Median ETT was 3.75 h (IQR 2-5 h, range 0.5-9 h). 74.1% of patients spent 2.25-9 h ETT. 44% of patients spent >4 h ETT. Median number of visits per patient was 34 (IQR 23-43; range 13-62). Median total ETT per patient was 127.5 h. Median ETT to the centre (1.75 h) was eight times greater than in the USA (13 min). More than 70% of patients attended for reasons other than chemotherapy. CONCLUSIONS Cancer patients endured a burden of long travel times in 2007. The prevailing policy of the Ministry of Health to build a single centralised modern centre would not have alleviated this burden. Based on these findings, three outlying cancer clinics were created which now provide non-radiotherapy oncology management of patients nearer their homes.