Effect of Travel Distance and Time to Radiotherapy on Likelihood of Receiving Mastectomy
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Breast-conserving surgery (BCS) followed by adjuvant radiation therapy (RT) is the standard of care for women with early-stage breast cancer as an alternative to mastectomy. The purpose of this study was to examine the relationship between receipt of mastectomy and travel distance and time to RT facility in New Jersey (NJ).
Data were collected from a cohort of 634 NJ women diagnosed with early-stage breast cancer. In patients receiving RT, the precise RT facility was used, whereas in patients not receiving RT, surgeons were contacted to determine the location of RT referral. Travel distance and time to RT facility from the patients’ residential address were modeled separately using multiple binomial regression to examine their association with choice of surgery while adjusting for clinical and sociodemographic factors.
Overall, 58.5 % patients underwent BCS with median travel distance to the radiation facility of 4.8 miles (vs. 6.6 miles for mastectomy) and median travel time of 12.0 min (vs. 15.0 min for mastectomy). Patients residing >9.2 miles compared with ≤9.2 miles from radiation facility were 44 % more likely to receive mastectomy. Additionally, patients requiring >19 min compared with ≤19 min of travel time were 36 % more likely to receive mastectomy.
These data found that travel distance and time from RT facility act as barriers to undergoing BCS in women with early-stage breast cancer. Despite being in an urban region, a significant number of women in NJ with early-stage breast cancer did not receive BCS.
The study team is grateful for medical, surgical and radiation oncologists and primary care physicians who understood the value of research and helped us obtain medical records of patients without which the conduct of the study would have been impossible. This work was supported by grants from the American Cancer Society (RSGT-07-291-01-CPHPS); the Susan G. Komen Breast Cancer Foundation (POP131006); the National Cancer Institute (R01CA133264, R01 CA100598, P01 CA151135, K22 CA138563, P30CA072720, P30 CA016056); US Army Medical Research and Material Command (DAMD-17-01-1-0334); the Breast Cancer Research Foundation; and a gift from the Philip L Hubbell family and the Buckingham Foundation.