An Investigation of Travel Distance and Timeliness of Breast Cancer Treatment Among a Diverse Cohort in the United States

Swann Arp Adams (), Oluwole Adeyemi Babatunde, Whitney E. Zahnd, Peiyin Hung, Karen E. Wickersham, Nathaniel Bell and Jan M. Eberth
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Swann Arp Adams: Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC 29208, USA
Oluwole Adeyemi Babatunde: Department of Psychiatry, Prisma Health, Greer, SC 29650, USA
Whitney E. Zahnd: Department of Health Policy and Management, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
Peiyin Hung: Health Services, Policy, and Management Department, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
Karen E. Wickersham: Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC 29208, USA
Nathaniel Bell: Institute for Families in Society, College of Social Work, University of South Carolina, Columbia, SC 29208, USA
Jan M. Eberth: Department of Health Management and Policy, Drexel University, Philadelphia, PA 19104, USA

IJERPH, 2025, vol. 22, issue 2, 1-13

Abstract: Travel to and from distant cancer treatment facilities can place a significant burden on cancer patients, particularly rural and minority survivors. Thus, the purpose of our investigation was to examine the association between patient travel distance and delays in types of treatment for breast cancer (surgery, radiation, chemotherapy, and hormonal therapy) and treatment delays. Using a novel linkage between the state cancer registry and administrative data from Medicaid and a private insurance plan, 2155 BC patients were successfully linked to create the cohort. ArcGIS was used to geocode all case residences and treatment facility addresses and calculate network distance between the residence and each facility. Logistic regression models were used to calculate the adjusted odds of being delayed versus timely by street distance. Odds of late surgery were increased by 1% (95% CI: 1.00, 1.01) for each one-mile increase from the patient’s residence to the treatment facility. In race-stratified models, the odds of late treatment for Black patients increased by 3% per mile (95% CI 1.01, 1.06) for radiation. Increased travel distance appears to significantly increase treatment delays for surgical, radiation, and chemotherapeutic treatments for women with BC, especially among Black women.

Keywords: breast neoplasm; medical geography; health care disparities; time-to-treatment; African Americans; rural populations (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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