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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.
Introduction:
Patients with rectal cancer travel varying distances to access specialized care; the travel distance may be associated with treatment selection and outcomes. The present study aimed to investigate variations in the distance traveled by patients with rectal cancer to receive treatment and assess its association with short-term and long-term outcomes.
Methods:
Using the National Cancer Database (2015-2021), a retrospective cohort study on 40,216 patients with stage II-III rectal adenocarcinoma who underwent proctectomy was conducted. The distance between patients' residences and treatment facilities was the primary exposure. Median distances were compared across patient, socioeconomic, and treatment subgroups. The travel distance was further analyzed as quartiles (Q1-Q4) to address skewness. Multiple linear, multivariable logistic regression, and Cox proportional hazard models were used to determine factors associated with and outcomes associated with travel distance.
Results:
The median distance traveled was 13 miles (IQR 5.7 31.4). Travel distance significantly varied by patient demographics, but not by tumor characteristics. Longer travel was noted among patients of <50 y, American Indians, patients with a Charlson score of 0, lower income, private or Medicare insurance, treated at academic centers, or living in rural areas. In the adjusted survival analysis, longer travel distance was significantly associated with increased overall survival (Q4 versus Q1 hazard ratio: 0.850, 95% confidence interval: 0.758-0.953, P = 0.005). Longer travel was not significantly associated with lower rates of conversion to laparotomy, 30-d mortality, or higher lymph node yield.
Conclusions:
Travel distance was associated with patient sociodemographic factors, including age, sex, race, income, and insurance. While a longer travel distance was associated with modest differences in perioperative outcomes, it was independently associated with improved survival.
