Travel-Time barriers to specialized cancer care for adolescents and young adults with acute leukemia.

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Abstract

BACKGROUND: Prior studies demonstrate that 20-50% of adolescents and young adults (AYA, age 15-39years) with acute lymphoblastic leukemia (ALL) receive care at specialty cancer centers (SCC); yet a significant survival benefit has been observed for patients at these sites. Our objective was to identify patients at risk of severe geographic barriers to SCC-level care.METHODS: We used data from the North American Association of Central Cancer Registries Cancer in North America database to identify AYA ALL patients diagnosed between 2004-2016 across 43U.S. states. We calculated driving distance and travel time from counties where participants lived to the closest SCC sites. We then used multivariable logistic regression models to examine the relationship between sociodemographic characteristics of counties where AYA ALLs resided and the need to travel >1hour to obtain care at an SCC.RESULTS: Among 11,813 AYA ALL patients, 43.4% were 25-39years old, 65.5% were male, 32.9% were Hispanic, and 28.7% had public insurance. We found 23.6% of AYA ALL patients from 60.8% of included U.S. counties would be required to travel >1hour one-way to access an SCC. Multivariable models demonstrate that patients living in counties that are non-metropolitan, with lower levels of educational attainment, with higher income inequality, lower internet access, located in primary care physician shortage areas and with fewer hospitals providing chemotherapy services are more likely to travel >1hour to access an SCC.CONCLUSIONS: Substantial travel-related barriers exist to accessing care at SCCs across the U.S, particularly for patients living in areas with greater concentrations of historically marginalized communities.

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