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Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study.

Authors :
Yee, Elliott K.
Coburn, Natalie G.
Zuk, Victoria
Davis, Laura E.
Mahar, Alyson L.
Liu, Ying
Gupta, Vaibhav
Darling, Gail
Hallet, Julie
Source :
Gastric Cancer; Jul2021, Vol. 24 Issue 4, p790-799, 10p
Publication Year :
2021

Abstract

Background: Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes. Methods: We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors. Results: Of 10,228 patients surviving a median 5.1 months (IQR: 2.0–12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63–0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53–0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02–1.13) for 11–50 km, hazard ratio 1.13 (95% CI 1.04–1.23) for 51–100 km]. Conclusion: A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
14363291
Volume :
24
Issue :
4
Database :
Complementary Index
Journal :
Gastric Cancer
Publication Type :
Academic Journal
Accession number :
150935849
Full Text :
https://doi.org/10.1007/s10120-021-01157-w