Distance Traveled to Head and Neck Cancer Provider: A Measure of Socioeconomic Status and Access

• Published in: Otolaryngology-head and neck surgery Vol. 162; no. 2; p. 193
• Main Authors: Massa, Sean T, Liebendorfer, Adam P, Zevallos, Jose P, Mazul, Angela L
• Format: Journal Article
• Language: English
• Published: England 01.02.2020
• Subjects: disparities; National Cancer Database; access to care; head and neck cancer; distance to provider
• ISSN: 1097-6817
• DOI: 10.1177/0194599819892015

Improved head and neck cancer survival has been associated with traveling farther distances for treatment, potentially due to patients seeking higher-quality facilities. This study investigates the role of both facility and confounding patient factors on this relationship. Review of national registry data. National Cancer Database. Adults with head and neck cancer diagnosed from 2004 to 2014 were identified. Overall survival was compared among distance-to-facility quartiles via univariate and multivariate survival models. Then, the analysis was stratified by facility and patient factors, and the association between distance and survival was compared among strata. Overall survival was worst in the shortest-distance quartile (<5 miles; median survival, 80.7 months; 95% CI, 79.2-82.3), while other distance groups showed similar survival (range, 96.4-104 months). This finding remained in the multivariate model (adjusted hazard ratio vs first distance quartile: 0.88; 95% CI, 0.87-0.89). The association between survival and distance persisted in all subgroups when stratified by facility volume and type (adjusted hazard ratio range, 0.82-0.91), suggesting that facility quality does not fully account for this association. When stratified by income, distance remained statistically associated with survival but with a smaller effect size than that of income. The association between distance to treating facility and head and neck cancer survival is limited to patients with worse survival outcomes living within 5 miles of the facility and is not fully explained by measures of facility quality.