The Relationship Between Travel Distance for Treatment and Outcomes in Patients Undergoing Radiation Therapy: A Systematic Review

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Introduction: While recent technological advances in radiotherapy have significantly improved treatment outcomes, the global distribution of radiotherapy is unbalanced, making access especially challenging for patients in rural or low-resource settings due to travel burden. This systematic review aims to explore the impact of geographic distance to treatment facilities on survival, as well as other treatment outcomes, among patients undergoing radiotherapy. Materials and MethodsA search of four databases (PubMed, Embase, CINAHL, and Web of Science) was performed. Studies were included if they were primary literature, published between May 2000 and May 2023, and reported the travel distances for patients undergoing radiotherapy for malignant conditions and its influence on survival outcomes. Studies were excluded if they did not report primary outcomes, were published before 2000, or were non-English. ResultsAfter review, twenty-three studies were included. Most studies were conducted in the United States, with cervical cancer being the most frequently studied disease site. Data suggested that travel distances vary significantly, with patients often traveling a median distance of 20 miles to radiotherapy. Among the studies, five reported a negative impact on overall survival, often associating greater travel with non-adherence to recommended care. Other survival metrics, including progression-free survival and all-cause mortality, were also assessed, demonstrating similar variability in relation to travel distance. Conversely, seven studies found no significant impact on overall survival, and four suggested a positive impact on overall survival, with improved outcomes at centers with higher case volumes. Some data also revealed an inverse correlation between travel distance and the likelihood of receiving guideline-concordant radiation therapy. ConclusionThe impact of travel distance on radiotherapy treatment outcomes is varied. Our findings underscore the challenges posed by travel in accessing radiotherapy and the disparities affecting particular patient demographic groups. Additional studies are needed to thoroughly assess the impacts of geographic disparities and to identify effective measures to address these challenges.