Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 24; no. 4; pp. 790 - 799
• Main Authors: Yee, Elliott K., Coburn, Natalie G., Zuk, Victoria, Davis, Laura E., Mahar, Alyson L., Liu, Ying, Gupta, Vaibhav, Darling, Gail, Hallet, Julie
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.07.2021; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Cancer; Cancer Research; Chemotherapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - therapy; Facilities and Services Utilization - statistics & numerical data; Female; Gastric cancer; Gastroenterology; Geographic information systems; Geographical distribution; Geography; Health care access; Health Services Accessibility - statistics & numerical data; Humans; Male; Medical Oncology - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Oncology; Ontario; Original Article; Outpatient Clinics, Hospital - statistics & numerical data; Patients; Population studies; Population-based studies; Referral and Consultation - statistics & numerical data; Regression analysis; Retrospective Studies; Socioeconomic factors; Stomach Neoplasms - mortality; Stomach Neoplasms - therapy; Surgical Oncology; Survival; Survival Rate; Ontario; Geography; Stomach; Outcomes; Esophagus; Cancer
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-021-01157-w

Background Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes. Methods We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors. Results Of 10,228 patients surviving a median 5.1 months (IQR: 2.0–12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63–0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53–0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02–1.13) for 11–50 km, hazard ratio 1.13 (95% CI 1.04–1.23) for 51–100 km]. Conclusion A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care.