Association between travel distance and choice of treatment for prostate cancer: does geography reduce patient choice?

Publication date: Available online 27 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Vinayak Muralidhar, Brent S. Rose, Yu-Wei Chen, Michelle D. Nezolosky, Paul L. Nguyen
ObjectiveThe choice of local therapy for patients with prostate cancer depends partially on patient preferences. We sought to determine whether the distance between a patient's home and treatment facility was related to the choice of treatment received among those opting for surgery or radiation.Materials/MethodsWe identified 222,804 patients diagnosed with NCCN low, intermediate, or high-risk N0M0 prostate cancer and treated with local therapy (surgery or radiation alone, with or without hormone therapy) using the National Cancer Database (NCDB). We used multivariable logistic regression to determine the rate of radiation therapy versus radical prostatectomy versus distance among patients living in rural and urban areas. Analyses were adjusted for geographic location within the US, age, race, Charlson/Deyo co-morbidity score, year of diagnosis, income quartile, education quartile, Gleason score, PSA, and T stage.ResultsPatients living in urban or rural areas were less likely to receive radiation compared to surgery if they lived farther from the treatment facility. Among urban patients living ≤5 miles of the treatment facility, 53.3% received radiation, compared to 47.0%, 43.6%, and 33.8% of those living 5-10, 10-15, or >15 miles away (p<0.001 in all cases). Similarly, rural patients were less likely to receive radiation the farther they lived from the treatment facility (≤25 miles: 62.3%; 25-50 miles: 55.5%; 50-75 miles: 38.4%; >75 miles: 23.8%; p<0.05 in all cases). These trends were also present when each risk group was analyzed separately.ConclusionPatients with prostate cancer in both urban and rural settings were less likely to receive radiation therapy rather than surgery the farther away they lived from a treatment center. These findings raise the possibility that the geographic availability of radiation treatment centers may be an important determinant of whether patients are able to choose radiation rather than surgery for localized prostate cancer.

Teaser

Patients with localized prostate cancer, which can be treated with either radiation or surgery, are less likely to receive radiation the farther away they live from a treatment facility. Distance to radiation treatment centers, which must be traveled daily by patients for several weeks, may be an important determinant of whether patients choose radiation therapy for prostate cancer.


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