Abstract P3-10-11: Influence of winter season, driving distance, and time on receipt of breast conserving therapy among Iowa urban and rural patients
Authors: Wolf CL , Frankova D , Franko J 
Published: March 2017

Abstract
BACKGROUND: The distance to treatment centers has been reported as a factor influencing the choice of mastectomy over breast conservation therapy (BCT) among breast cancer patients, potentially enhancing disparities for rural patients. We analyzed the impact of crowfly and driving distance to the radiation center and winter season on patient choice of BCT versus mastectomy among breast cancer patients.
METHODS & SETTINGS: Our patient base included 3223 stage 0-3 breast cancer patients treated between 2002 and 2015. Treatment was provided at an established breast center serving urban, suburban, and rural patients in central Iowa.
RESULTS: Crowfly distance (19±22 miles, range 0-160, median 8.7) was consistently shorter as compared to true driving distance (25±27 miles, 0-205, 12.8). One-quarter patients drove over 33 miles (equivalent of 38 minutes). There was tight correlation between crowfly and driving distance (Spearman's rho=0.989, p&lt;0.001) and time (0.985, p&lt;0.001).
In univariate analysis, there was no significant difference in crowfly, driving distance, and driving time in minutes to the radiation center between BCT and mastectomy patients (19.3±22.5 vs 18.4±21.6 miles, p = 0.317; 25.1±27.5 vs 24.4±27.0 miles, p = 0.585; 29.9±25.3 vs 29.5±24.9 minutes, p = 0.664).
Receipt of BCT was not predicted by crowfly or true driving distance, driving time, or season. There was no interaction between distance, winter season, and drive time. Receipt of BCT was more likely with older age (OR=1.02 per year of age, p&lt;0.001) and later year of treatment (OR=1.05, p&lt;0.001).
CONCLUSION: Driving distance, time, and crowfly distance correlated tightly and do not influence patient choice of surgery type for breast cancer in our population. Despite a substantial rural population, driving distance, driving duration, and climate did not significantly influence patients' decisions for mastectomy versus BCT.BACKGROUND: The distance to treatment centers has been reported as a factor influencing the choice of mastectomy over breast conservation therapy (BCT) among breast cancer patients, potentially enhancing disparities for rural patients. We analyzed the impact of crowfly and driving distance to the radiation center and winter season on patient choice of BCT versus mastectomy among breast cancer patients.
METHODS & SETTINGS: Our patient base included 3223 stage 0-3 breast cancer patients treated between 2002 and 2015. Treatment was provided at an established breast center serving urban, suburban, and rural patients in central Iowa.
RESULTS: Crowfly distance (19±22 miles, range 0-160, median 8.7) was consistently shorter as compared to true driving distance (25±27 miles, 0-205, 12.8). One-quarter patients drove over 33 miles (equivalent of 38 minutes). There was tight correlation between crowfly and driving distance (Spearman's rho=0.989, p&lt;0.001) and time (0.985, p&lt;0.001).
In univariate analysis, there was no significant difference in crowfly, driving distance, and driving time in minutes to the radiation center between BCT and mastectomy patients (19.3±22.5 vs 18.4±21.6 miles, p = 0.317; 25.1±27.5 vs 24.4±27.0 miles, p = 0.585; 29.9±25.3 vs 29.5±24.9 minutes, p = 0.664).
Receipt of BCT was not predicted by crowfly or true driving distance, driving time, or season. There was no interaction between distance, winter season, and drive time. Receipt of BCT was more likely with older age (OR=1.02 per year of age, p&lt;0.001) and later year of treatment (OR=1.05, p&lt;0.001).
CONCLUSION: Driving distance, time, and crowfly distance correlated tightly and do not influence patient choice of surgery type for breast cancer in our population. Despite a substantial rural population, driving distance, driving duration, and climate did not significantly influence patients' decisions for mastectomy versus BCT.
Citation Format: Wolf CL, Frankova D, Franko J. Influence of winter season, driving distance, and time on receipt of breast conserving therapy among Iowa urban and rural patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-11.