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Patients who travel farther for cancer care have better survival

Last Updated: 2003-09-17 12:00:16 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Compared to cancer patients who live close to their treatment centers, those who have a commute of more than 15 miles for treatment appear to survive longer, according to a report in the September 17th issue of the Journal of the National Cancer Institute.

"Prior research has suggested that patients who travel out of their neighborhood for elective care from specialized medical centers may have better outcomes than local patients with the same illnesses who are treated at the same centers," write Dr. Elizabeth B. Lamont, of Massachusetts General Hospital Cancer Center, Boston, and colleagues.

The researchers studied associations between overall survival and progression-free survival and the distance traveled from the patient home to the treatment center for 110 cancer patients over 7 years. All the patients were taking part in phase II curative-intent chemoradiotherapy protocols for locoregionally advanced squamous cell cancers of the head and neck at the University of Chicago.

The researchers used Cox regression analysis, adjusting for demographic, disease, and treatment factors. A positive association was observed between the distance patients traveled for their treatment and survival.

Patients who traveled more than 15 miles for treatment had one-third the risk of death of those who lived closer to their treatment center (hazard ratio = 0.32). Age, race, family income, smoking history, and tumor stage were also significantly associated with survival.

"After adjusting for the previously mentioned variables (i.e., patients age, race, family income, neighborhood income, tumor stage, larynx site, smoking history, Karnofsky performance status, and protocol), the hazard of death decreased by 3.2% (hazard ratio = 0.97) with each 10 miles the patients traveled for treatment," Dr. Lamont and colleagues explain. They observed similar results for progression-free survival.

"Our study formally documents something clinical researchers in oncology have long appreciated," the authors write. "That is, on average, those patients who are able and willing to 1) research therapeutic options (or have agents who will do so for them) and 2) find and expend the resources necessary to then receive those therapies seem to fare better than those patients who end up at the closest place for care, even if their disease and treatments are apparently the same."

"Our results suggest that further work is needed to better characterize which individual (e.g. better overall health, greater unmeasured wealth, personality traits, greater compliance) and social [e.g. social capital, social networks] factors travel distance is mediating," they add.

J Natl Cancer Inst 2003;95:1370-1375.

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