Abstract 1928: Travel distance and pattern of care for laryngeal cancer in Kentucky

Abstract

Abstract Introduction: Previous studies have found that access to medical care was associated with stage at cancer diagnosis and receipt of treatment. For laryngeal cancer, radiation related treatments are a preferred option in the majority of cases. Travel distance to the radiation facilities may impact patient access to radiation treatment, especially in a rural mountainous state such as Kentucky. The aim of the study is to assess the influence of travel distance to the nearest radiation center and other factors on inclusion of radiation in the first course treatment for laryngeal cancer. Study Population and Methods: 1995-2006 Kentucky Cancer Registry data were used for this study. A total of 2099 patients age 20 and older at diagnosis with no previous history of cancer and with known TNM stage laryngeal cancer (C32.0-C32.2) were included for the analysis. The road travel distance from their home address to the nearest radiation center was calculated based on road network in GIS. Poverty rate and high school education rate at census tract level were linked with the case data. The SAS procedure GLIMMIX was used to fit random intercept logistic models to predict the association between treatment and other demographic and clinic factors. Results: About 78% of patients received treatment that included radiation as part of first course treatment. The rate of radiation related treatment increased from 68% to 79% in the study period. The average travel distance was 13.5 miles for the group receiving radiation treatment vs. 13.9 miles for the group not receiving radiation treatment. The multivariate logistic model indicated that the travel distance was not associated with radiation treatment. In addition, patients diagnosed recently (per year) were more likely to have radiation related treatment (OR=1.05, p=0.001), and patients treated in large hospitals were positively associated with radiation treatment (OR=2.72, p=0.002) than patients in small hospitals. Conclusions: Although longer travel distance has been found as a barrier for cancer patients living in this rural state, we did not find a similar association for laryngeal cancer. The increasing use of radiation related treatment is encouraging and may be associated with increasing availability of radiation centers in this region. Under utilization of radiation treatment for patients treated in smaller hospitals is a serious concern. Further research is needed to investigate the cause of this under utilization. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1928. doi:10.1158/1538-7445.AM2011-1928