Distance travelled for oral, breast, and cervical cancer care and its association with stage and treatment patterns: Analysis from the hospital-based cancer registries in India
Thilagavathi Ramamoorthy, Gokul Sarveswaran, Anita Nath, Saravanan Vijayakumar, Prashant MathurBackground and objectives
Geographic accessibility is a key determinant of timely and equitable cancer care. In India, uneven distribution of cancer services often requires long-distance travel, influencing stage at diagnosis and treatment patterns. This study quantified travel distance to cancer care and examined its association with stage at presentation, timeliness, and treatment modalities.
Methods
Data from 83 hospital-based cancer registries under the National Cancer Registry Programme, India were analysed. Travel distance was estimated between district centres and reporting institutes and summarised as median distances. Multivariable logistic regression estimated adjusted odds ratios (aORs) for associations with stage at diagnosis, time to treatment initiation, and treatment patterns.
Results
Nearly half of patients accessed care within 100 km, while 12.9% travelled >500 km. Median travel distances were shorter in Kerala (67 km, IQR:5-148), Karnataka (68 km, IQR:9-203), and Maharashtra (32 km, IQR:4-151), and substantially longer in Bihar (484 km, IQR:128-2058), Jharkhand (1609 km, IQR:272-1752), and Odisha (1410 km, IQR:368-1601). Cross-regional care seeking was prominent towards western and central India. Long-distance travel was associated with higher odds of advanced stage (aOR:1.28), higher likelihood of surgery (aOR:1.49), and lower likelihood of initiating treatment within 31 days (aOR:0.88).
Interpretation and conclusions
Distance travelled is a key indicator of access to cancer care in India, affecting stage at diagnosis, timeliness, and treatment. While longer travel may reflect preference for perceived higher-quality care at specialised centres, it is also linked to advanced disease and treatment delays. Strengthening decentralised care and referral systems is essential to reduce travel burden and improve equity in outcomes.