Association of Travel Burden with Definitive Prostate Cancer Treatment: A United States Registry Cohort Study
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Purpose
Prostate cancer (PCa) mortality disparities are partly driven by unequal access to care. Transportation barriers may limit access to definitive treatment. We studied how driving travel time affects receipt of definitive PCa treatment.
Materials and Methods
We conducted a cohort study of men with non-metastatic PCa (2000 - 2015; follow-up through 2018) across the metropolitan area cancer registries of seven US states. Travel burden was estimated using Google Maps isochrones representing driving time thresholds to reach the hospital appended to geomasked residential addresses. Outcomes were “no treatment, “ “radical surgery,” or “radiotherapy”. Covariate-adjusted multinomial logistic regression with interaction terms assessed modification by sociodemographic factors.
Results
The study included 132,939 men, of whom 37.0% received no treatment, 41.0% underwent surgery, and 22.0% received radiotherapy. Longer driving time (≥90 min vs <30 min) was associated with higher radical prostatectomy (aOR: 1.07, 95% CI: 1.03, 1.12), but lower radiotherapy (0.72, 95% CI: 0.69 - 0.76). Subgroup analyses revealed higher surgery associated with longer driving times among those in nSES Q1 (aOR: 1.33, 95% CI: 1.21-1.45) vs Q5 (aOR: 0.94, 95% CI: 0.86-1.04), those in low (aOR: 1.16, 95% CI: 1.09-1.24) vs high (aOR: 1.03, 95% CI: 0.98-1.09) population density areas, and those with regional (aOR: 1.30, 95% CI: 1.14-1.48) vs localized (aOR: 1.05, 95% CI: 1.00 -1.09) disease. Longer driving time was mostly associated with lower odds of radiotherapy across sociodemographic subgroups.
Conclusions
Higher travel burden was associated with lower radiotherapy receipt, but greater surgery use in deprived and rural patients, which warrants further investigation.
