Abstract B15: Association between travel distance to a comprehensive cancer center and breast cancer stage, treatment, and outcomes in a rural state
Authors: Jethwa Krishan , Settergren Brooke , Berg Brittany , Beal James 
Published: May 2019

Abstract
Purpose: The purpose of this study was to investigate the association between travel distance to a comprehensive cancer center on initial stage of breast cancer diagnosis, treatment, and survival. Women with breast cancer living in rural locations in the Midwest may be at an increased risk by having to travel longer distances, often in inclement weather, to receive screening and treatment.
Methods: A hospital-based retrospective chart review was conducted of women (n=260) diagnosed with incident breast cancer from January 1, 2007 through December 31, 2007 and receiving treatment at a comprehensive cancer center in Fargo, ND. The women resided predominantly from southeastern North Dakota and southwestern Minnesota. Women aged 29-94 years were included in the study. Women were excluded if they were non-white or had a prior cancer history. Demographic and clinical data recorded included: age at diagnosis, zip code, diagnosis, stage of disease at diagnosis, radiation, surgery, mortality and history of previous cancer. Travel distance was categorized as follows: 0-&lt;15 miles, 15-44 miles, 45-59 miles, and &gt;60 miles. Stage at diagnosis was categorized as Early (0-2) and Late (3-4). Surgery was categorized as breast-conserving surgery and mastectomy. SPSS 20.0 for Windows was used to perform analysis. Chi-square test was used and Mantel-Haenszel test for linear association was used to compare distance category to stage and treatment. ANOVA was used to compare age. A P value &lt;.05 was considered statistically significant. Institutional Review Boards of both Sanford Health System and the University of North Dakota approved the study.
Results: The mean age at diagnosis was 60 years (range 29-94). The 5-year survival rate was 95.5%. There were 38.1% (n=99) women residing within 15 miles of the cancer center, 12.6% (33) between 15-44 miles, 21.5% (56) between 45-59 miles, and 27.7% (72) greater than 60 miles. The distribution of staging was 17.1% (42) stage 0, 46.9% (115) stage 1, 25.3% (62) stage 2, 7.8% (19) stage 3, and 2.9% (7) stage 4. Surgical resection was performed on 98% (255) of women, with 59.2% (151) receiving breast-conserving surgery, and 40.3% (104) receiving mastectomy. Radiotherapy was performed on 61.5% (160) women.
A linear trend association was found between travel distance and stage of diagnosis (p=0.03). The further the distance the more likely women were to have a later stage of diagnosis. Similarly, linear trend association was found between travel distance and surgery type (p=0.005). The further the distance the more likely women were to have a mastectomy. No association was found between travel distance and age of diagnosis, receipt of radiotherapy, or 5-year survival.
Conclusion: This study indicates that women with increased travel distances are more likely to have a later stage at diagnosis and mastectomy at surgery. Improvements in access to cancer treatment may be necessary for women in rural areas.
Citation Format: Krishan Jethwa, Brooke Settergren, Brittany Berg, James Beal. Association between travel distance to a comprehensive cancer center and breast cancer stage, treatment, and outcomes in a rural state. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B15.