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  11. Travel Burden And Bypassing Closest Site For Surgical Cancer Treatment For Urban And Rural Oncology Patients

Travel burden and bypassing closest site for surgical cancer treatment for urban and rural oncology patients

Tracy Onega1, Niveditta Ramkumar2, Gabriel A Brooks3,4

  • 1Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.

The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association
|October 12, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

Most cancer patients, especially those in rural areas, bypass the nearest surgical facility. This bypass is linked to lower 90-day and 1-year mortality rates for surgical cancer care.

Area of Science:

  • Oncology
  • Health Services Research
  • Rural Health
Keywords:
bypasscancerruralsurgical oncology

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Background:

  • Geographic access to surgical cancer care is a critical determinant of patient outcomes.
  • Rural populations often face greater travel burdens for specialized medical services, potentially impacting cancer care delivery and survival.

Purpose of the Study:

  • To examine the relationship between travel burden for surgical cancer care and patient rurality, geographic bypass of the nearest surgical facility, cancer type, and mortality outcomes.
  • To investigate how bypassing the closest surgical facility influences mortality for Medicare beneficiaries with common cancers.

Main Methods:

  • Utilized Medicare claims and enrollment data from 2016-2018 for patients with colon, rectal, lung, or pancreatic cancer.
  • Measured travel times to the nearest and utilized surgical facilities, analyzing bypass patterns in relation to rurality and surgical rates.
  • Employed multivariable regression to assess the association of bypassing with 90-day postoperative and 1-year mortality, with rurality as an effect modifier.

Main Results:

  • 25.5% of beneficiaries with cancer resided in non-metropolitan areas; 78% of small town/rural patients bypassed their closest facility.
  • Bypassing the nearest facility was associated with a reduced likelihood of both 90-day (OR=0.79) and 1-year (OR=0.81) mortality.
  • The most significant reduction in 1-year mortality from bypassing was observed for pancreatic cancer, particularly in rural areas (OR=0.46).

Conclusions:

  • The majority of Medicare beneficiaries with lung, colon, rectal, or pancreatic cancer bypass the closest surgical facility, with higher rates among rural patients.
  • Bypassing the nearest surgical facility was associated with improved survival outcomes, including lower 90-day and 1-year mortality.
  • Further research into the determinants of bypassing, especially for rural patients, is crucial for improving cancer care and reducing disparities.
travel burden