Distance from cancer facility as a barrier to timely treatment among patients with non-metastatic cervical cancer

Globally, cervical cancer remains the leading cause of cancer death in women in many countries and in the United States it is the second most common cause of cancer death in younger women age 20–39 years. Distance from treatment facility may contribute to treatment delay and ultimately, disease outcomes. We hypothesize that greater distance from the treating facility results in a treatment delay among women with non-metastatic cervical cancer. Data for 36,986 subjects with non-metastatic cervical cancer treated with definitive radiation or surgery between 2004 and 2015 were selected from the National Cancer Database. Subjects were excluded if they had missing information, variant histology, treatment >180 days from diagnosis, or lived >1000 miles from their facility. Univariate comparisons were performed using chi-square and analysis of variance. Multivariable linear regression was used to investigate the effect of distance quartile on time to treatment while adjusting for significant patient and disease characteristics. Results: The mean age was 49.5 years, 16.2% of women were black, 14.2% were Hispanic, 48.7% had private insurance, 98.4% lived in urban/metro counties, and 56.1%received surgery versus radiation as initial treatment. Multivariable analysis identified a treatment delay of 1.1 days for distance quartile 2 (p = 0.008), 2.0 days for quartile 3 (p < 0.001), and 4.0 days for quartile 4 (p < 0.001) compared to women in the closest quartile. Other patient and disease characteristics were significantly associated with treatment delay. Interestingly, women living in rural counties were treated over 8.5 days earlier than those from the most populous metropolitan counties (p < 0.001). In conclusion: Greater distance from treatment facility resulted in a statistically significant delay in treatment.

Cervical cancer; Treatment disparity; Time to treat; Distance; National cancer database; Urbanization

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