Distance Traveled and Disparities in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal...

Area of Science:

• Oncology
• Surgical Oncology
• Health Services Research

Background:

• Investigating the influence of travel distance on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) outcomes is crucial.
• Understanding patient travel patterns can inform healthcare accessibility and resource allocation for complex cancer treatments.

Purpose of the Study:

• To analyze the relationship between distance traveled by patients and outcomes following CRS and HIPEC.
• To identify potential disparities in access to care and treatment quality based on patient travel distance.

Main Methods:

• Retrospective analysis of a prospectively managed single-center CRS/HIPEC database (1992-2022).
• Patient distance calculated via zip codes and linked to census data for socioeconomic information.
• Patients categorized into local (≤50 miles), regional (51-99 miles), and distant (≥100 miles) groups.
• Statistical analyses included descriptive statistics, Kaplan-Meier survival, and Cox regression.

Main Results:

• 1614 patients traveled a median of 109.5 miles; 53% traveled ≥100 miles.
• Distant travelers were more often white, affluent, educated, and less likely to be uninsured or on Medicaid.
• Higher Peritoneal Carcinomatosis Index (PCI) scores and R2 resections were observed in distant travelers.
• Median survival did not differ significantly across distance groups; distance was not a predictor of survival.

Conclusions:

• Over half of patients traveled over 100 miles for CRS/HIPEC, suggesting potential for regionalization.
• While survival was not affected by distance, disparities in access and higher surgical complexity (PCI, R2 resection) in distant travelers warrant attention.
• Further research is needed to address potential barriers for underserved populations and ensure equitable access to high-quality CRS/HIPEC treatment.