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Travel distance impacts adjuvant chemotherapy receipt following a colectomy
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Patients with colon cancer who have to travel greater distances for treatment appeared less likely to receive adjuvant chemotherapy regardless of their insurance status, according to findings from a joint study conducted by ASCO, the American Cancer Society and the American Society for Radiation Oncology.
Many patients — especially those with colon cancer — do not receive the recommended chemotherapy following surgery. There is little data to suggest why patients forgo adjuvant chemotherapy within 90 days of surgery despite recommendations from evidence-based treatment guidelines.
Chun Chieh “Anna” Lin, PhD, epidemiologist in the health services research program of the American Cancer Society, and colleagues compared travel distance, insurance status and the density of oncologists in a given area to the likelihood of receiving adjuvant chemotherapy within 90 days of surgery for colon cancer.
The researchers used the National Cancer Data Base to identify 34,694 patients aged 18 to 80 years diagnosed with stage III colon cancer between 2007 and 2010.
From this cohort, 75.7% of the patients received adjuvant chemotherapy within 90 days of their colectomy.
Patients who traveled 50 to 249 miles for their cancer care were 13% (OR = 0.87; 95% CI, 0.78-0.96) less likely to receive adjuvant chemotherapy than those patients who traveled 12.5 miles or less. Patients who had to travel 250 miles or more for treatment were 64% (OR = 0.36; 95% CI, 0.28-0.45) less likely to receive adjuvant chemotherapy than those who traveled 12.5 miles or fewer.
The density level of oncologists in certain areas did not appear associated with receipt of chemotherapy when analyzed alone; however, patients who were uninsured or using public insurance who resided in low-density areas were 15% (OR = 0.85; 95% CI, 0.73-0.98) less likely to receive adjuvant chemotherapy.
“While it is reassuring that most patients in this study received adjuvant chemotherapy on time, the fact that patients travelling more than 50 miles were less likely to receive chemotherapy, regardless of insurance status, is still concerning,” Lin said in a press release. “It tells us expanded insurance coverage, while important, might not fully address the barriers to patients receiving guideline-recommended treatment.”
The researchers acknowledged the National Cancer Data Base only includes data from patients diagnosed and treated at Commission on Cancer-accredited facilities, and even though that accounts for 70% of annual incident cancers, it may reduce the generalizability of these findings.
Additional limitations included possible chemotherapy treatment locations outside of accredited facilities, the exclusion of oncologists who have not billed Medicare in the previous 12 months, possibility for underestimation of travel distance, and a lack of data on physician or patient preferences.
“More in-depth analysis to focus on low-density areas would help analyze how interventions to decrease geographic barriers may improve the access to colon cancer treatment,” the researchers concluded. “Understanding how insurance can be a barrier to quality cancer care is increasingly important because the number of people with Medicaid coverage has expanded under the Affordable Care Act.” – by Anthony SanFilippo
Disclosure: Lin reports no relevant financial disclosures. The other researchers report speakers bureau roles with Astellas, Bayer, Genentech/Roche, Lilly and Sanofi, research funding from 21st Century Oncology, Genentech/Roche and Merck Serono, and employment with the American Society for Radiation Oncology.
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