Geographic disparities amongst patients with gynecologic malignancies at an urban NCI-designated cancer center

Abstract

Objective: Women with gynecologic malignancies require specialized care. We hypothesize that a geographic disparity exists amongst patients with gynecologic malignancies and that longer distance and time traveled negatively impact completion of adjuvant therapy.

Methods: Patients with incident gynecologic malignancies at a single, urban NCI-designated cancer center were identified. Distances from the patient's home to the treating facility were calculated in miles and minutes. Demographic variables were evaluated for their impact on treatment outcomes using Chi-squared, ANOVA and Kruskal-Wallis analyses.

Results: One hundred and fifty consecutive patients were identified. The median distance traveled to the hospital was 16.9miles with a median travel time of 28min. The distance and time traveled were significantly different between insurance groups, with the uninsured traveling the furthest for care by distance (p=0.04) and time (p=0.03). Race, tumor site, medical comorbidities and median income at zip code were not associated with travel distance or time to the hospital. The majority of patients (87%) completed recommended initial treatment. Treatment completion was related to distance traveled with those patients living at the distance extremes (<10miles or >50miles) least likely to complete care (p<0.01). The presence of medical comorbidities (p<0.01) but not insurance status was correlated to treatment completion.

Conclusions: Geographic disparities exist in women with gynecologic malignancies receiving treatment at an NCI-designated cancer center. Approaches to decreasing these disparities may include improved support for cancer patients needing assistance with travel and additional social work and psychosocial support to patients with medical co-morbidities.

Keywords: Disparities; Gynecologic cancer; Treatment adherence.