Travel burdens to access care among children with cancer between 2016 and 2019: Analysis of a national population-based cancer registry in Japan

Abstract

Background: Centralization of cancer care increases survival but increases the travel burden (i.e., travel durations, distances, and expenditures) in visiting hospitals. This study investigated the travel burdens to access cancer care for children aged 18 years and younger in Japan.

Methods: The study population comprised 10,709 patients diagnosed between 2016 and 2019 obtained from a national population-based cancer registry in Japan. Their residences were classified as urban or rural. We counted the number of patients treated at specialized hospitals and investigated the treatment centralization across diagnostic groups by Pareto plot. Travel burdens to access care were estimated using a route-planner web service and summarized using median values. A multivariable logistic model was performed to investigate factors associated with the events of car travel duration exceeding 1 h.

Results: Of the patients, 76.7% lived in urban areas, and 82.5% received treatment in designated hospitals for childhood cancer. The Pareto plot suggested that the top five hospitals treated 63.5% of patients with retinoblastoma. The estimated travel burdens for all patients were 0.62 h (0.57 h in urban areas and 1.00 h in rural areas), 16.9 km, and 0.0 dollars of toll charges. Regarding travel duration, 21.7% of patients had travel exceeding 1 h, and rural areas, retinoblastoma, malignant bone tumors, and childhood cancer-hub hospitals were associated with travel duration exceeding 1 h (adjusted odds ratios of 6.93, 3.59, 1.94, and 1.91, respectively).

Conclusions: Most patients were treated in specialized hospitals and the treatments for specific diseases were centralized. However, most patients were estimated to travel less than 1 h, and the travel burden tended to increase for patients in rural areas, those with specific diseases, and those going to specialized hospitals. Cancer control measures in Japan have steadily improved centralized treatment while keeping the travel burden relatively manageable.

Fig 1. Patient flow.

CNS, central nervous system; ICCC-3, 3rd edition of the International Classification of Childhood Cancer; ICD-O-3, 3rd edition of the International Classification of Diseases for Oncology.

Fig 2. Area division and the specialized hospital in Japan.

Thick lines indicate the boundaries of the seven regions. The Chugoku and Shikoku regions were combined into one region, and the Kyushu and Okinawa regions were combined into one region, resulting in seven regional divisions. Thin lines indicate the boundaries of the 47 prefectures. Green circles indicate childhood cancer-hub hospitals designated in 2013 or 2019. This map was created from data on the Digital National Land Information download service under a CC BY license, with permission from the Information Utilization Division, Real Estate and Construction Economy Bureau, Ministry of Land, Infrastructure, Transport and Tourism, original copyright 2015 and 2021, respectively [28, 29].

Fig 3. Pareto plot of the number of patients that were treated in each hospital by diagnostic group.

CNS, central nervous system; Malignant epithelial neo., other malignant epithelial neoplasms. The x-axis presents the cumulative percentage of hospitals to the total number of hospitals that provided treatment by diagnosis group. The y-axis presents the cumulative percentage of patients treated at each hospital to the total number of patients by diagnosis group; the cumulative percentage of patients was calculated in the descending order of the number of patients treated in each hospital.