Association Between Geographic Access to Cancer Care and Receipt of Radiation Therapy for Rectal Cancer

Journal Article · Tue Mar 15 00:00:00 EDT 2016 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2015.12.012· OSTI ID:22645123

Bruinooge, Suanna S.; Kirkwood, M. Kelsey ^[1]; Hershman, Dawn L. ^[2]; Jemal, Ahmedin ^[3]; Guadagnolo, B. Ashleigh ^[4]; Yu, James B. ^[5]; Hopkins, Shane ^[6]; Goldstein, Michael ^[7]; Bajorin, Dean ^[8]; Giordano, Sharon H. ^[4]; Kosty, Michael ^[9]; Arnone, Anna ^[10]; Hanley, Amy ^[1]; Stevens, Stephanie ^[10]; Olsen, Christine ^[11]

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1. American Society of Clinical Oncology, Alexandria, Virginia (United States)
2. Columbia University Medical Center, New York, New York (United States)
3. American Cancer Society, Atlanta, Georgia (United States)
4. MD Anderson Cancer Center, Houston, Texas (United States)
5. Yale University School of Medicine, New Haven, Connecticut (United States)
6. William R. Bliss Cancer Center, Ames, Iowa (United States)
7. Beth Israel Deaconess Medical Center, Boston, Massachusetts (United States)
8. Memorial Sloan Kettering Cancer Center, New York, New York (United States)
9. Scripps Clinic, San Diego, California (United States)
10. American Society for Radiation Oncology, Fairfax, Virginia (United States)
11. Massachusetts General Hospital, Boston, Massachusetts (United States)

Purpose: Trimodality therapy (chemoradiation and surgery) is the standard of care for stage II/III rectal cancer but nearly one third of patients do not receive radiation therapy (RT). We examined the relationship between the density of radiation oncologists and the travel distance to receipt of RT. Methods and Materials: A retrospective study based on the National Cancer Data Base identified 26,845 patients aged 18 to 80 years with stage II/III rectal cancer diagnosed from 2007 to 2010. Radiation oncologists were identified through the Physician Compare dataset. Generalized estimating equations clustering by hospital service area was used to examine the association between geographic access and receipt of RT, controlling for patient sociodemographic and clinical characteristics. Results: Of the 26,845 patients, 70% received RT within 180 days of diagnosis or within 90 days of surgery. Compared with a travel distance of <12.5 miles, patients diagnosed at a reporting facility who traveled ≥50 miles had a decreased likelihood of receipt of RT (50-249 miles, adjusted odds ratio 0.75, P<.001; ≥250 miles, adjusted odds ratio 0.46; P=.002), all else being equal. The density level of radiation oncologists was not significantly associated with the receipt of RT. Patients who were female, nonwhite, and aged ≥50 years and had comorbidities were less likely to receive RT (P<.05). Patients who were uninsured but self-paid for their medical services, initially diagnosed elsewhere but treated at a reporting facility, and resided in Midwest had an increased the likelihood of receipt of RT (P<.05). Conclusions: An increased travel burden was associated with a decreased likelihood of receiving RT for patients with stage II/III rectal cancer, all else being equal; however, radiation oncologist density was not. Further research of geographic access and establishing transportation assistance programs or lodging services for patients with an unmet need might help decrease geographic barriers and improve the quality of rectal cancer care.

• OSTI ID: 22645123
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 94, Issue 4; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
MEDICAL PERSONNEL
NEOPLASMS
PATIENTS
RADIOTHERAPY
RECEIPTS
RECTUM