Impact of travel burden on overall survival in patients with lung cancer.

Abstract

6522 Background: High-volume specialized centers are more efficient at managing patients with lung cancer than low-volume centers. Centralization of cancer treatment has the potential to improve patient outcomes and quality of treatment. However, the growing centralization also increases patient’s travel burden (measured as travel distance or travel time) and may negatively impact access to specialist services. The aim of our study was to evaluate the potential impact of travel burden on clinical outcomes in patients with lung cancer. Methods: A retrospective analysis of a single Bulgarian center was performed. A total of 9240 lung cancer patients treated between 2005-2020 were included in the study. Travel distance between patients’ city of residence and the treating facility was calculated with an online tool to determine the shortest route for travel using the existing road network. The mean of travel time values for every workday of the week was calculated to control for daily changes in typical traffic. The probability of survival was estimated using the Kaplan-Meier method and differences in survival in each subgroup were evaluated with a log-rank test. Results: About one third of all included patients were living in the same city as the treating facility (n = 2746, 29.7%). The medians for travel distance and travel time were used to stratify patients into subgroups. According to travel distance the patients were grouped into three strata – same city, < 50 km and ≥ 50 km. A cut-off of 60 min was used to stratify patients into three groups by travel time – same city, < 60 min and ≥ 60 min. Overall survival in our patient population was significantly lower with increasing travel distance (p < 0.001, Mantel-Cox log rank) and travel time (p < 0.001, Mantel-Cox log rank). The 1-year OS rate according to travel distance was 27.1% in the same city group, 22.4% in < 50 km group and 20.5% in ≥ 50 km group (p < 0.001). The corresponding values for the 5-year OS rate were: 2.9%, 2.6% and 1.4% (p < 0.001). Conclusions: In this retrospective study we discovered significant differences in overall survival of patients with lung cancer depending on travel distance and travel time to the treating oncological facility. Despite having similar clinical and pathological characteristics (age, sex, stage at initial diagnosis, histologic subtype), the median overall survival was significantly lower in those subgroups of patients with a higher travel burden. [Table: see text]