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Motorized travel time to access childhood cancer care in India: A multi-center geospatial analysis
Manraj Singh Sra1, K J Aksithanand1, Shuvadeep Ganguly2
1Association for Socially Applicable Research (ASAR), Pune, India.
Insights
Children in India face long travel times to access pediatric cancer care, with over 73% traveling more than 60 minutes. This highlights the urgent need to expand specialized cancer services beyond major cities.
Area of Science:
- Pediatric Oncology
- Health Services Research
- Geographic Access to Care
Background:
- Limited geographic access to specialized care hinders childhood cancer outcomes in India.
- Significant delays in diagnosis and treatment are linked to travel burdens.
Purpose of the Study:
- To evaluate motorized travel times for children seeking care at three major Indian childhood cancer centers.
- To identify factors associated with prolonged travel times for pediatric cancer patients.
Main Methods:
- Retrospective analysis of individual patient data (2005-2019) from three tertiary hospitals in India.
- Geocoding of patient residences and estimation of travel times using GIS data and Dijkstra's algorithm.
- Exploratory logistic regression to identify predictors of travel time exceeding 60 minutes.
Main Results:
- A total of 22,328 children were included, with a median travel time of 161 minutes.
- 73.5% of patients traveled over 60 minutes to reach cancer centers.
- Male sex and solid malignancies were associated with prolonged travel times; significant inter-center variations in travel time were observed.
Conclusions:
- Children with cancer in India experience substantial travel time burdens.
- Expansion of pediatric oncology services beyond urban referral centers is crucial.
- Policy interventions are needed to strengthen regional networks and improve referral systems.
Background:
Delays in diagnosis and treatment, driven in part by limited geographic access to specialized care, continue to hinder childhood cancer outcomes. In this study, we aimed to evaluate motorized travel times for children seeking care at three referral childhood cancer centers in India.
Methods:
This multi-center retrospective study analyzed individual-patient level data for children (aged ≤19 years) diagnosed with cancer between 2005 and 2019 at three tertiary hospitals in India: All India Institute of Medical Sciences (AIIMS) and Rajiv Gandhi Cancer Institute (RGCI) in New Delhi, and Women's Indian Association (WIA) Cancer Institute in Chennai. Patient residential addresses were geocoded, and travel times were estimated using Malaria Atlas Project friction surface rasters and Dijkstra's algorithm. An exploratory logistic regression analysis was performed to identify factors associated with prolonged motorized travel time (>60 min).
Results:
A total of 22,328 patients with a median age of 10 years (IQR 4-15), 32·5% (n = 7261) female, and 54·2% (n = 12,093) with solid malignancies were included. The median motorized travel time was 161 min (IQR 27-430), with 73·5% of patients traveling > 60 min. Male sex (aOR 1·23, 95% CI: 1·15-1·31; p < 0·001) and solid malignancies (aOR 1·09, 95% CI: 1·03-1·16; p = 0·004) were associated with prolonged travel time. Compared with AIIMS, WIA had higher odds (aOR 2·79, 95% CI: 2·58-3·03) and RGCI had lower odds (aOR 0·69, 95% CI: 0·65-0·74) of prolonged travel time (p < 0·001).
Conclusion:
Children with cancer in India face a substantial travel time burden to access cancer care, highlighting the need for expansion of pediatric oncology services.
Policy Summary:
There is a need for policies that expand pediatric oncology capacity beyond major urban referral centers, strengthen regional treatment networks, and improve referral systems to reduce delays and disparities in diagnosis and treatment and improve childhood cancer outcomes.
