Impact of geospatial barriers on breast cancer care in Haiti: a retrospective cohort study

Abstract

Although geospatial barriers to cancer care are recognised, data quantifying their magnitude and impact on treatment and outcomes in low-income and middle-income countries are scarce. The objective of this study was to describe the geospatial distribution of patients receiving care for breast cancer at a tertiary hospital in Haiti. We analysed data from a retrospective cohort of female patients with breast cancer at a tertiary health-care cancer centre in Haiti. We estimated travel time between hospital and geographic centroids of patient's home section communes using the origin-to-destination cost-matrix analysis function of ArcGIS version 10.7. The analysis accounted for road network and other geographic features. Patients were categorised by the resultant travel time into: less than 1 h, 1-2 h, or more than 2 h. Odds ratios (OR), adjusted for poverty level, were used to describe association between travel time and stage at diagnosis, and between travel time and obtaining curative breast surgery. The primary cohort included 341 patients with non-metastatic breast cancer, diagnosed between June 1, 2012, and Dec 31, 2016, and excluded 374 patients with metastatic disease. Most patients (164 [48%]) resided less than 1 h from the hospital included in the analysis, compared with 92 (27%) residing 1-2 h away and 85 (25%) residing more than 2 h of travel away. Urban residents were more likely to live within 2 h of the hospital (p<0·001). The OR for metastatic disease among patients residing more than 2 h away from the hospital was 1·37 (95% CI 0·96-1·95), compared with individuals living less than 1 h away. Compared with urban dwellers within 2 h of care, the ORs for having metastatic disease were 1·34 (0·93-1·93) for rural dwellers within 2 h, 1·81 (1·12-2·93) for urban dwellers more than 2 h, and 1·23 (0·80-1·89) for rural dwellers more than 2 h. Compared with urban dwellers within 2 h of care, the OR for receiving curative surgery was 0·39 (0·13-1·15) for rural dwellers living more than 2 h away. Longer travel times increased the odds of having metastatic breast cancer at diagnosis. Although the difference was not significant, patients residing in rural areas and with longer travel times were less likely to receive curative surgery. Interventions to mitigate the impact of geospatial barriers are essential to improving breast cancer outcomes in low-income and middle-income countries. Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, MA, USA.