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Variations in the Distance Traveled by Patients With Rectal Cancer to Receive Care and Its Association With Outcomes
Sameh Hany Emile1, Maher Al Khaldi2, Zubair Bayat2
1Colorectal Surgery Department, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Patients traveling farther for rectal cancer treatment showed improved survival rates, despite variations linked to demographics and insurance. This distance did not impact short-term outcomes like mortality or surgical conversion.
Area of Science:
- Oncology
- Health Services Research
- Epidemiology
Background:
- Rectal cancer patients travel varying distances for specialized care.
- Travel distance may influence treatment choices and patient outcomes.
- Understanding these variations is crucial for equitable cancer care.
Purpose of the Study:
- To examine travel distance variations for rectal cancer patients.
- To assess the association between travel distance and short-term/long-term outcomes.
- To identify demographic and socioeconomic factors influencing travel distance.
Main Methods:
- Retrospective cohort study of 40,216 stage II-III rectal adenocarcinoma patients (2015-2021).
- Analysis of National Cancer Database data, focusing on travel distance from residence to treatment facility.
- Utilized regression models to determine factors associated with travel distance and its impact on outcomes.
Main Results:
- Median travel distance was 13 miles; significant variations observed across demographic and socioeconomic groups, but not tumor characteristics.
- Longer travel distances were associated with improved overall survival (HR 0.850, P=0.005).
- No significant association found between travel distance and lower conversion to laparotomy, 30-day mortality, or lymph node yield.
Conclusions:
- Travel distance correlates with patient sociodemographic factors (age, race, income, insurance).
- Longer travel distances were independently linked to improved survival in rectal cancer patients.
- While perioperative outcomes showed modest differences, survival benefit suggests potential advantages of specialized centers.
