A new study in Gynecologic Oncology found that one in five women with ovarian cancer would not be willing to travel an additional 50 miles for cancer treatment for a 6% chance of a 5-year survival benefit. In contrast, the majority of surveyed women required a 5-year survival benefit of 6% or less to justify the additional travel. Almost half of the participants reported they would travel at least 250 miles for a 6% 5-year survival benefit.
“The women most likely to face this tradeoff are the 9% of the United States population living in counties more than 50 miles distant from the closest gynecologic oncologist, and the 15% of the United States population living in a Hospital Referral Region without a gynecologic oncologist,” wrote David I. Shalowitz, MD, of the Department of Obstetrics and Gynecology at Wake Forest University in Winston-Salem, NC, and colleagues. “These low-access regions of the United States should therefore be the first to benefit from interventions to 1) decrease the burdens of travel for women with ovarian cancer, 2) extend high-volume cancer care networks to underserved areas, including virtual and in-person outreach by gynecologic oncologists, and 3) improve the quality of the clinical care infrastructure at lower-volume cancer centers.”
Patients with ovarian cancer have been shown to reap better clinical outcomes when treated at high-volume institutions. As a result, there have been discussions of centralization of ovarian cancer care at these centers.
The authors conducted a survey of women presenting with a pelvic mass at one of two clinics between February 2015 and February 2016 to determine how women would balance survival benefit against additional travel to centralized treatment centers. Participants completed two discrete choice experiments. One assessed the 5-year survival benefit that would be needed to justify an additional 50 miles of travel, and the other assessed the additional distance the patients would travel to achieve a 6% 5-year survival benefit.
Sixty-two women took part in the survey. Results showed that 81% stated they required a 5-year survival benefit of ≤6% to justify an additional 50 miles of travel. These respondents were less likely to be employed and more likely to rate their health as good to excellent compared with those who said they were unwilling to travel this distance for the benefit.
Similarly, 80% of the participants said that they would travel ≥50 miles if it meant a 6% 5-year survival benefit.
“We were unable to identify any significant demographic, geographic, or psychosocial differences between the groups of participants willing to travel an additional 50 miles for a 6% improvement in 5-year survival and those unwilling to travel, though at least one discrete choice experiment suggested that patients who are healthier, not currently employed, and less connected to their local neighborhood may be more willing to travel greater distances for care,” the researchers wrote. “Larger-scale study of cancer patients’ willingness to travel for care may reveal predictive characteristics not captured in this study; however, it is possible that willingness to travel is not reducible to other measurable factors.”
The authors noted that the study was limited by small sample size and geographical bias. The majority of participants lived in eastern Pennsylvania and southern New Jersey, which is a relatively densely populated area with multiple gynecologic oncology centers.
“As always, the aim of policy changes should be to ensure that all women are able to reap the benefits of high-quality ovarian cancer care, regardless of where they reside,” the authors concluded.
To read more about this study, click here.