Quantifying the Travel Undertaken by Cancer Patients Receiving Radiotherapy in Victoria, Australia

Abstract

This study aimed to investigate the travel distance for cancer patients treated with radiotherapy in Victoria, Australia, during a 9-year period relative to their home address. Additionally, the study aimed to quantify 'excess' travel distance where patients travelled to treatment centers that were not their closest. The PRedicting the health economic IMPact of new and current CAncer Treatments (PRIMCAT) dataset was used for the study. PRIMCAT is a multi-institution research initiative taking a data-driven modelling approach to understand and forecast cancer treatment utilization in Australia. The PRIMCAT dataset is a comprehensive linked dataset including a retrospective cohort of patients 18 years and over, diagnosed with cancer included in the Victorian Cancer Registry between January 2010 to December 2019. For each patient in the cohort, data linkage includes a range of datasets managed by state and federal health departments including the Victorian Radiotherapy Minimum Dataset. A distance matrix was constructed using the Google Distance Matrix API that included driving distance between postcodes of selected patients and the postcodes of radiotherapy facilities. The centroid of each post-code was used for driving distance measurements. We first analyzed the realized travel distances of patients followed by the excess travel by patients. The excess travel was further quantified separately for public and private radiotherapy facilities. There were 86,408 unique patient-radiotherapy courses available and of sufficient data quality to analyze. Patients travelled an average of 42.5km (s.d. = 72.2km) one-way, with a median travel distance of 16.5km. The largest distance travelled was 723km with 95% of patients travelling between 0km and 257km. Of the patients who received radiotherapy in a public facility, 44.3% travelled to a facility that was not their closest public facility. The average excess travel of these patients was 26.8km, with the median excess travel being 13.6km. Additionally, of patients who received care in a public facility, 47.4% travelled past a closer private facility. The average excess travel distance of these patients was 23.1km and the median excess travel was 11.5km. In the case of patients who received radiotherapy at a private facility, 92.8% travelled to a clinic that was not their closest. The average excess of these patients was 36.6km with a median excess travel distance of 15.6km. Access to radiotherapy facilities remains unequal in Victoria with some patients having to travel significantly greater distances than average. This significant travel may require patients to take time off work or live away from home presenting additional financial challenges. The reasons for the large travel distances and any excess travel have not yet been identified but will be the subject of further study.