Bridging the Gap: Examining the Association of Travel Burden With Treatment Administration and Survival in Stage II/III Gastric Cancer
Asimina Courelli, Lola Van Doosselaere, Lailie Kahsai, Endel John Orav, Ryan Broderick, Andrew M. Lowy, Samir Gupta, Winta Tsegay MehtsunPURPOSE
Travel burden has been identified as a source of care disparities in other malignancies, but its impact on gastric cancer care is poorly understood. Therefore, we investigated the impact of travel burden on treatment administration for stage II/III patients and its association with survival.
METHODS
This was a retrospective cohort study among patients diagnosed with stage II/III gastric cancer from 2004 to 2021 in the National Cancer Database. Travel burden was measured as distance from treatment facility to patient's ZIP code (great circle distance [GCD]). We analyzed differences in treatment administration across GCD categories and the impact of GCD on overall survival (OS).
RESULTS
We identified 16,826 patients with stage II/III gastric cancer in the following GCD categories: 0-25 miles (n = 11,301 [67.2%]), 25-50 miles (n = 2,566 [15.3%]), 50-100 miles (n = 1,746 [10.4%]), and 100-300 miles (n = 1,213 [7.2%]). Patients in high GCD categories experienced increased rates of delays in care initiation (0-25 miles: 13.7%, 100-300 miles: 17.1%,
CONCLUSION
Increased travel burden was associated with delayed treatment administration and increased care fragmentation and was independently associated with increased mortality, particularly in patients traveling 100-300 miles. Understanding the impact of travel burden on gastric cancer care and outcomes can help guide future resource allocation for patients.