Association between travel distance and survival among women with locally advanced cervical cancer treated with radiotherapy

Objectives: Regionalization of care in which patients are selectively referred to specialized or high-volume centers has been associated with improved survival for many oncologic procedures. Given the increase in regionalization of cancer care, we sought to examine the effect of travel distance on outcomes of patients with locally advanced cervical cancer receiving radiation therapy. Methods: We used the National Cancer Database to identify women with stage IB2-IVA cervical cancer diagnosed from 2005-2016 who were treated with primary radiation. Patients who received 180 days after diagnosis were excluded. The linear distance from the centroid of each patient's zip code of residence to the radiation facility was calculated. Patients were divided based on travel distance into approximately four equal quartiles. Multivariable models were developed to determine factors associated with greater travel distance (fourth quartile). The association between travel distance and survival was estimated using Cox proportional hazards models. A sensitivity analysis comparing patients treated at low volume, local hospitals to those who traveled to high volume hospitals was performed. Results: Among 12,576 patients identified, the median travel distance was 9.6 miles. Patients in the highest quartile traveled ≥23.0 miles. Factors associated with increased travel (the highest quartile) included younger age, White race, higher neighborhood socioeconomic status and educational attainment, and residence in a rural area (P Download : Download high-res image (88KB) Download : Download full-size image Conclusions: Overall there was no association between distance travelled to receive radiation and survival for women with locally advanced cervical cancer. However, compared to patients who received care locally at a low volume center, survival is improved for women who travel a longer distance to a high-volume center.