Insurance Status and Travel Distance to Single Treatment Facility Predictive of Mastectomy

2022 ◽  
Vol 270 ◽  
pp. 22-30
Author(s):  
Kelly A. Stahl ◽  
Daleela Dodge ◽  
Elizabeth J. Olecki ◽  
Rolfy Perez Holguin ◽  
Christopher McLaughlin ◽  
...  
Keyword(s):  
Travel Distance ◽  
Insurance Status ◽  
Single Treatment ◽  
Treatment Facility

scholarly journals Impact of travel distance to the treatment facility on overall mortality in US patients with prostate cancer

Cancer ◽  
2017 ◽  
Vol 123 (17) ◽  
pp. 3241-3252 ◽  
Author(s):  
Malte W. Vetterlein ◽  
Björn Löppenberg ◽  
Patrick Karabon ◽  
Deepansh Dalela ◽  
Tarun Jindal ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Travel Distance ◽  
Treatment Facility ◽  
Overall Mortality

Lung Cancer in Nonelderly Patients: Facility and Patient Characteristics Associated With Not Receiving Treatment

2019 ◽  
Vol 17 (8) ◽  
pp. 931-939 ◽  
Author(s):  
Elizabeth A. Nardi ◽  
Can-Lan Sun ◽  
Francisco Robert ◽  
Julie A. Wolfson
Keyword(s):  
Lung Cancer ◽  
Los Angeles ◽  
Private Insurance ◽  
Multivariable Analysis ◽  
Small Cell ◽  
Cancer Surveillance ◽  
Disease Stage ◽  
Insurance Status ◽  
Treatment Facility ◽  
Race Ethnicity

Background: In elderly patients with lung cancer, race/ethnicity is associated with not receiving treatment; however, little attention has been given to nonelderly patients (aged ≤65 years) with a range of disease stages and histologies. Nonelderly patients with lung cancer have superior survival at NCI-designated Comprehensive Cancer Centers (CCCs), although the reasons remain unknown. Patients and Methods: A retrospective cohort study was conducted in 9,877 patients newly diagnosed with small cell or non–small cell lung cancer (all stages) between ages 22 and 65 years and reported to the Los Angeles County Cancer Surveillance Program registry between 1998 and 2008. Multivariable logistic regression examined factors associated with nontreatment. Results: In multivariable analysis, race/ethnicity was associated with not receiving cancer treatment (black: odds ratio [OR], 1.22; P=.004; Hispanic: OR, 1.17; P=.04), adjusting for patient age, sex, disease stage, histology, diagnosis year, distance to treatment facility, type of facility (CCC vs non-CCC), and insurance status. With inclusion of socioeconomic status (SES) in the model, the effect of race/ethnicity was no longer significant (black: OR, 1.02; P=.80; Hispanic: OR, 1.00; P=1.00). Factors independently associated with nontreatment included low SES (OR range, 1.37–2.15; P<.001), lack of private insurance (public: OR, 1.71; P<.001; uninsured: OR, 1.30; P<.001), and treatment facility (non-CCC: OR, 3.22; P<.001). Conclusions: In nonelderly patients with lung cancer, SES was associated with nontreatment, mitigating the effect of race/ethnicity. Patients were also at higher odds of nontreatment if they did not have private insurance or received cancer care at a non-CCC facility. These findings highlight the importance of understanding how both patient-level factors (eg, SES, insurance status) and facility-level factors (eg, treatment facility) serve as barriers to treatment of nonelderly patients with lung cancer.

Do insurance status and neighborhood characteristics explain why minorities underutilize NCI cancer centers?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6010-6010
Author(s):  
Lyen C. Huang ◽  
Yifei Ma ◽  
Justine V Ngo ◽  
Kim F Rhoads
Keyword(s):  
Clinical Trials ◽  
Low Socioeconomic Status ◽  
Patient Discharge ◽  
Primary Diagnosis ◽  
Travel Distance ◽  
Insurance Status ◽  
Chi Square ◽  
Cancer Centers ◽  
Chi Square Analysis ◽  
White Patients

6010 Background: National Cancer-Institute (NCI) designated cancer centers provide some of the highest quality cancer care in the US, in part due to the availability of cutting edge technologies and access to cancer clinical trials. Racial/ethnic minorities suffer from persistent disparities in cancer outcomes, and these groups are typically under-represented in clinical trials. This may be due in part to under-utilization of NCI centers by these groups. Methods: A unique dataset linking the California Cancer Registry with California patient discharge abstracts was used to identify patients undergoing resection for a primary diagnosis of colorectal cancer (CRC) (1996-2006). Travel distance to treatment hospital was determined using GIS software. Chi-square analysis correlated patient demographics, clinical characteristics, insurance status, and neighborhood socioeconomics with NCI center use. Multivariable regression models were constructed to predict the likelihood of using an NCI center. Results: 95,994 CRC patients were identified. Median travel distance for care was <5 miles. Only 12,659 (13%) lived within a 5 mile radius of an NCI center; and of those, fewer than 10% used the center for CRC care (n=1130). Black (OR 0.83 95%CI 0.72-0.95) and Hispanic (OR 0.72 95%CI 0.65-0.81) patients were less likely than white patients to use NCI centers. Neighborhood socioeconomics, but not insurance status, were significantly correlated with NCI under-utilization. Asian populations were more likely to use NCI centers than white patients (OR 1.40 95%CI 1.28-1.54). Conclusions: Black and Hispanic patients are less likely to use nearby NCI hospitals for CRC care. Outreach efforts in communities with low socioeconomic status and educational attainment may increase use of NCI centers, improve CRC outcomes, and increase minority enrollment in clinical trials.

scholarly journals Association Between Geographic Access to Cancer Care, Insurance, and Receipt of Chemotherapy: Geographic Distribution of Oncologists and Travel Distance

2015 ◽  
Vol 33 (28) ◽  
pp. 3177-3185 ◽  
Author(s):  
Chun Chieh Lin ◽  
Suanna S. Bruinooge ◽  
M. Kelsey Kirkwood ◽  
Christine Olsen ◽  
Ahmedin Jemal ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Travel Distance ◽  
Study Cohort ◽  
Insurance Status ◽  
Density Level ◽  
Low Density ◽  
Geographic Access ◽  
Cancer Data ◽  
To Receive

Purpose Geographic access to care may be associated with receipt of chemotherapy but has not been fully examined. This study sought to evaluate the association between density of oncologists and travel distance and receipt of adjuvant chemotherapy for colon cancer within 90 days of colectomy. Patients and Methods Patients in the National Cancer Data Base with stage III colon cancer, diagnosed between 2007 and 2010, and age 18 to 80 years were selected. Generalized estimating equation clustering by hospital service area was conducted to examine the association between geographic access and receipt of oncology services, controlling for patient sociodemographic and clinical characteristics. Results Of 34,694 patients in the study cohort, 75.7% received adjuvant chemotherapy within 90 days of colectomy. Compared with travel distance less than 12.5 miles, patients who traveled 50 to 249 miles (odds ratio [OR], 0.87; P = .009) or ≥ 250 miles (OR, 0.36; P < .001) had decreased likelihood of receiving adjuvant chemotherapy. Density level of oncologists was not statistically associated with receipt of adjuvant chemotherapy (low v high density: OR, 0.98; P = .77). When stratifying analyses by insurance status, non–privately insured patients who resided in areas with low density of oncologists were less likely to receive adjuvant chemotherapy (OR, 0.85; P = .03). Conclusion Increased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with nonprivate insurance who resided in low-density oncologist areas were less likely to receive adjuvant chemotherapy. If these findings are validated prospectively, interventions to decrease geographic barriers may improve the timeliness and quality of colon cancer treatment.

Effect of distance to radiation treatment facility on use of radiation therapy after mastectomy in elderly women

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6030-6030
Author(s):  
R. S. Punglia ◽  
J. C. Weeks ◽  
B. A. Neville ◽  
C. C. Earle
Keyword(s):  
Radiation Therapy ◽  
Elderly Women ◽  
Radiation Treatment ◽  
Quality Care ◽  
Patient Characteristics ◽  
Sociodemographic Factors ◽  
Geographic Region ◽  
Travel Distance ◽  
Treatment Facility ◽  
Definitive Surgery

6030 Background: Post-mastectomy radiation therapy (PMRT) has been shown to improve survival in patients at high risk for local or regional recurrence. However, radiation therapy necessitates daily travel to treatment centers for several weeks. We sought to study the effect of distance to the nearest radiation treatment facility on receipt of PMRT in elderly women. Methods: Using the linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we analyzed 19,787 women with Stage I or II breast cancer who received mastectomy as definitive surgery between 1991 and 1999. Multivariable logistic regression was used to investigate the association of travel distance with receipt of PMRT after adjusting for clinical and sociodemographic factors. Results: Overall, 2,075 (10.5%) patients treated with mastectomy received PMRT. In addition to cancer and patient characteristics, increasing distance from the nearest radiation treatment facility was independently associated with a decreased likelihood of receiving PMRT, (OR = 0.996 per additional mile, p = 0.01). The decline in PMRT use appeared at distances greater than 25 miles and was statistically significant for those patients living greater than 75 miles from the nearest radiation facility (odds of receiving PMRT of 0.58 [95% CI: 0.34–0.99] versus those living within 25 miles of such a facility). In secondary analyses, the effect of distance was only significant in women aged 75–80 years (OR = 0.992 per additional mile, p = 0.03), and those above the age of 80 (OR = 0.989, p = 0.02). When analyses were conducted separately by geographic region, the effect of distance was only significant in the Midwest (OR = 0.992, p = 0.014). The effect of distance was not significant (OR = 1.00, p = 0.87) among women with positive nodes, but was significant in women with no positive nodes (OR = 0.992, p = 0.013). Conclusions: Oncologists must be cognizant of the potential barrier to quality care that is posed by travel distance, especially for elderly patients. Mechanisms to ameliorate the effect of distance on receipt of radiation therapy by assisting individuals with transportation limitations or policies to decrease the centralization of RT services, may help to remove barriers to potentially life-saving treatment. No significant financial relationships to disclose.

Association between travel distance and use of postoperative radiation therapy among men with organ-confined prostate cancer: Does geography influence treatment decisions?

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 24-24
Author(s):  
Melaku A Arega ◽  
David Yang ◽  
Trevor Joseph Royce ◽  
Brandon Arvin Virgil Mahal ◽  
Edward Christopher Dee ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radiation Treatment ◽  
Travel Distance ◽  
Adjuvant Radiation ◽  
Postoperative Radiation ◽  
Treatment Facility ◽  
Postoperative Radiation Therapy ◽  
Pathologic Features ◽  
Treatment Facilities

24 Background: Following radical prostatectomy, men with adverse pathologic features or a persistent post-operative detectable PSA are candidates for postoperative radiation therapy (PORT). Previous data have suggested disparities in receipt of adjuvant radiation therapy for adverse pathologic features according to travel distance. Among patients without adverse pathologic features (pT2 disease and negative margins), the main indication for PORT is a persistent post-operative detectable PSA. However, it remains unknown whether the rate of receipt of PORT in this cohort of men with persistently detectable PSA is related to travel distance from the treating facility. Methods: Using the National Cancer Database, we identified 287,274 men with prostate cancer diagnosed in 2004-2015 managed with upfront surgery who were found to have pT2 disease with negative surgical margins. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% confidence intervals (95CI) of receiving PORT as the primary dependent variable and distance ( < 5, 5-10, 10-20, > 20 miles from the treatment facility) as the primary independent variable. Results: Within our cohort, progressively farther distance from the treatment facility was associated with lower rates of PORT. In patients living < 5 miles, 5-10 miles, 10-20 miles, and > 20 miles from the treating facility, rates of PORT were 1.52% (referent), 1.23% (AOR 0.86, 95CI 0.78-0.96), 1.11% (AOR 0.81, 95CI 0.73-0.90), and 0.65% (AOR 0.43, 95CI 0.38-0.47), respectively (p < 0.005 in pairwise comparisons). Conclusions: For men with localized prostate cancer without adverse pathologic features managed with surgery, increasing distance from treatment facility was associated with lower receipt of PORT. Given that the rate of a persistent post-operative detectable PSA is unlikely to depend on the distance to the treatment facility, these findings raise the possibility that the geographic availability of radiation treatment facilities influences the decision to undergo PORT for patients with persistent post-operative detectable PSA.

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