Abstract B012: An investigation of travel distances for breast cancer treatment among a racially and socioeconomically diverse cohort
Authors: Heiney Sue P. , Truman Samantha C. , Babatunde Oluwole , Alvarado Christian R. , Adams Swann Arp 
Published: August 2020

Abstract
Background: In South Carolina, black women are less likely to be diagnosed with breast cancer, but yet are more likely to die with their disease. The disparity is estimated to be as great as 60% higher for black women compared to white women after accounting for the lower incidence. Distances that cancer patients travel to receive treatments are likely to influence treatment decisions and ultimately survival; however, this relationship is not well described.
Purpose: The purpose of this investigation was to compare average travel distances for each modality of breast cancer treatment including surgery, chemotherapy, radiation therapy, and hormonal therapy. We furthermore examined the impact of these distances on disease-free survival.
Methods: SC Central Cancer Registry data (2002-2010) were linked to administrative data from Medicaid or another private payor insurance plan. Eligibility criteria included white or black race and continuous enrollment in their respective insurance plan for 3 years post diagnosis. Network distances from the patient residence to the provider were calculated by Arc GIS. T-tests and chi-square tests were used to compare descriptive statistics as appropriate. Cox proportional hazards models were used to assess the relationship between treatment travel distances and survival.
Results: Patients in the cohort traveled an average distance of 20, 21, 19, and 7 miles for surgical, chemotherapy, radiation therapy, and hormone therapy (pharmacy). Travel distances were significantly higher for blacks for chemotherapy (23 vs 20 miles, p=0.03), but not for any other therapy modalities. As might be expected, patients residing in rural areas had significantly higher travel distances for all treatment modalities, including hormonal therapies. In comparison to urban-dwelling patients, rural residents traveled an average of 36 vs 17 miles for surgery (p&lt;0.01), 37 vs. 17 miles for chemotherapy (p&lt;0.01), 34 vs. 16 miles for radiation therapy (p&lt;0.01), and 23 vs 6 miles for hormone therapy (p=0.01). In examining survival, no travel distance was significantly associated with increased morality.
Conclusion: Rural residents traveled significantly longer distances to receive their cancer care compared to urban-dwelling residents; however, this did not appear to impact survival in this cohort. Additional work is needed to fully understand the influence of travel distances on treatment decisions that may ultimately impact survival. These findings highlight the need for innovative solutions to improve access to care for rural residents.
Citation Format: Sue P. Heiney, Samantha C. Truman, Oluwole Babatunde, Christian R. Alvarado, Swann Arp Adams. An investigation of travel distances for breast cancer treatment among a racially and socioeconomically diverse cohort [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B012.