Ringstrom Mark J, Christian Jay, Bush Matthew L, Levy Jeffrey E, Huang Bin, Gal T J
Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY, United States of America.
Department of Epidemiology, University of Kentucky, Lexington, KY, United States of America.
Am J Otolaryngol. 2018 Sep-Oct;39(5):575-581. doi: 10.1016/j.amjoto.2018.06.020. Epub 2018 Jun 28.
The objective was to examine the impact of travel distance on stage of presentation and treatment choices in head and neck squamous cell carcinoma in the rural setting.
6029 cases diagnosed from 2002 to 2011 were obtained from the state cancer registry. Travel time was calculated to the nearest academic medical centers, otolaryngologist, and radiation treatment facilities. Multivariate logistic regression was used to examine the association of travel time with stage of presentation as well as the likelihood of appropriate therapy after adjustment for other demographic variables.
Patients in the highest quartile for travel distance to academic centers were 33% more likely to present with early stage disease (p = 0.02), and 42% more likely to receive appropriate surgical therapy for oral cavity cancer. Patients were 70% more likely to receive appropriate surgery if they were farthest from the nearest radiation center (p = 0.03). Proximity to otolaryngology care was not significant.
Increased travel distance to academic medical centers is associated with increased likelihood of proper therapy for surgically treated tumors of the head and neck. Impact on these findings on improvements in access to care is discussed.
本研究旨在探讨在农村地区，就诊距离对头颈部鳞状细胞癌的分期及治疗选择的影响。
从州癌症登记处获取了2002年至2011年确诊的6029例病例。计算了到最近的学术医疗中心、耳鼻喉科医生和放射治疗机构的就诊时间。采用多因素逻辑回归分析，在调整其他人口统计学变量后，研究就诊时间与疾病分期以及接受适当治疗可能性之间的关联。
到学术中心就诊距离处于最高四分位数的患者，出现早期疾病的可能性高33%（p = 0.02），接受口腔癌适当手术治疗的可能性高42%。如果患者距离最近的放射中心最远，则接受适当手术的可能性高70%（p = 0.03）。距离耳鼻喉科护理机构的远近无显著影响。
到学术医疗中心的就诊距离增加，与头颈部手术治疗肿瘤接受适当治疗的可能性增加相关。讨论了这些发现对改善医疗可及性的影响。
