Introduction

To investigate the impact of travel distance to the treating facility on the overall mortality (OM)-risk of patients with prostate cancer (PCa) in the United States.

Methods

We identified 775,999 PCa patients within the National Cancer Data Base 2004-2012. Independent predictors of travel distance (intermediate [12.5-49.9miles] and long [49.9-249.9miles] vs. short [<12.5miles]) and the effect of distance on OM were calculated using multivariate regression analyses. Additional analyses evaluated the distance effect on OM in all patients and in selected subgroups.

Results

Overall, 54.5%, 33.4%, and 12.1% traveled short, intermediate, and long distances, respectively. Residency in rural area, and receiving treatment at academic/high-volume centers independently predicted long travel distance. Non-Hispanic blacks and Medicaid- insured were less likely to travel long distances (all P<0.001). At multivariate analysis, traveling intermediate distance (hazard ratio [HR]=0.97; 95% confidence interval (CI)=0.95-0.99; P<0.001) and long distance (HR=0.87; 95% CI=0.83-0.92; P<0.001) were associated with lower OM risk, as compared to short distance (Figure 1). In subgroup analyses, long travel distance was associated with decreased OM in non-Hispanic whites, privately-insured, Medicare-insured, and patients treated at academic or high-volume centers (P<0.001), but not in non-Hispanic blacks (P=0.3). Long travel distance was associated with an increased OM in Medicaid- insured patients (P<0.001; Figure 2).

Conclusions

Our results suggest that interestingly not only patients traveling longer distances live longer, but that even if they are going the extra mile, their OM outcomes are likely to be influenced by baseline socioeconomic and facility specific factors. Specifically, we observed concerning socioeconomic disparities in the access to care regarding a higher travel burden, which translated into less favorable OM outcomes for non-Hispanic blacks and non-privately insured patients.

Funding

None