Relationship of travel distance with patient demographics, advance care planning, and survival in early-phase clinical trials (EP-CTs).
Authors: Durbin Sienna , Lundquist Debra , Healy Megan , Lynch Kaitlyn , Bame Viola , Martin Tristan , Johnson Andrew , Turbini Victoria , Juric Dejan , Jimenez Rachel , Nipp Ryan David 
Published: June 2022

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Background: EP-CTs are often conducted at large academic centers, which may require some patients to travel further for their care. Little is known about either the distance EP-CT participants travel for their care or the association of distance traveled with patient characteristics and outcomes. Methods: We retrospectively reviewed the electronic health records of consecutive patients enrolled in EP-CTs at Massachusetts General Hospital from 2017-2019 to obtain patient characteristics (demographics and clinical factors) and outcomes (including time spent on trial, survival, and presence or absence of an advance care planning [ACP] discussion, defined as documentation of a code status or goals of care conversation in the medical record). We also used patients’ home zip codes to derive the social deprivation index (SDI; a composite demographic measurement from 0-100 quantifying social determinants of health, with higher numbers indicating more disadvantage). To estimate distance traveled, we calculated the miles traveled in one direction driving from home zip code to trial site. We used descriptive statistics to compare patient characteristics and outcomes for those traveling < 50 miles (short distance) versus those traveling 50+ miles (long distance). Results: Among 421 patients (median age = 63.0 years, 56.9% female, 97.6% metastatic disease), median distance traveled was 36.4 miles. Half of patients (n = 217; 51.5%) traveled 50+ miles to receive care on trial. There were no significant differences between those traveling short and long distances in most patient characteristics evaluated, including age (60.9 vs 60.6 years; p = 0.635), sex (53.9% female vs 57.6%; p = 0.447), race (85.3% white vs 84.8%; p = 0.346), marital status (71.8% married vs 69.3%; p = 0.586), insurance (51% private vs 54.4%; p = 0.266), cancer type (22.5% GI vs 21.2%; p = 0.666), prior lines of therapy (52.5% one-two lines vs 51.2%; p = 0.981), and performance status (62.3% ECOG 1 vs 66.8%; p = 0.270. However, those with a higher SDI score were less likely to travel a long distance for trial participation (mean SDI 36.7 for short distance vs 30.5 for long distance; p = 0.026). Patients traveling a long distance were less likely to have a documented ACP discussion (48.8% vs 66.7%; p < 0.001). We found no significant difference in time spent on trial between those traveling short and long distances (mean days: 98 vs 93.5; p = 0.175) or in time from coming off trial to death (mean days: 147.7 vs 153.7; p = 0.099). Conclusions: We found that half of EP-CT participants travel 50+ miles in one direction to their trial site, with disparities in travel distance based on the social deprivation index. Notably, those traveling long distances were less likely to have a documented ACP discussion. Our findings suggest several unmet needs in the EP-CT population and highlight opportunities for future intervention development.