De Leo Alexandra N, Giap Fantine, Culbert Matthew M, Drescher Nicolette, Brisson Ryan J, Cassidy Vincent, Augustin Etzer Michelet, Casper Anthony, Horowitz David H, Cheng Simon K, Yu James B
Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.
Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA.
Radiat Oncol J. 2023 Jun;41(2):108-119. doi: 10.3857/roj.2023.00164. Epub 2023 Jun 22.
Patients with cancer are particularly vulnerable to coronavirus disease (COVID). Transportation barriers made travel to obtain medical care more difficult during the pandemic. Whether these factors led to changes in the distance traveled for radiotherapy and the coordinated location of radiation treatment is unknown.
We analyzed patients across 60 cancer sites in the National Cancer Database from 2018 to 2020. Demographic and clinical variables were analyzed for changes in distance traveled for radiotherapy. We designated the facilities in the 99th percentile or above in terms of the proportion of patients who traveled more than 200 miles as "destination facilities." We defined "coordinated care" as undergoing radiotherapy at the same facility where the cancer was diagnosed.
We evaluated 1,151,954 patients. There was a greater than 1% decrease in the proportion of patients treated in the Mid-Atlantic States. Mean distance traveled from place of residence to radiation treatment decreased from 28.6 to 25.9 miles, and the proportion traveling greater than 50 miles decreased from 7.7% to 7.1%. At "destination facilities," the proportion traveling more than 200 miles decreased from 29.3% in 2018 to 24% in 2020. In comparison, at the other hospitals, the proportion traveling more than 200 miles decreased from 1.07% to 0.97%. In 2020, residing in a rural area resulted in a lower odds of having coordinated care (multivariable odds ratio = 0.89; 95% confidence interval, 0.83-0.95).
The first year of the COVID pandemic measurably impacted the location of U.S. radiation therapy treatment.
癌症患者特别容易感染冠状病毒病（COVID）。在疫情期间，交通障碍使前往就医变得更加困难。这些因素是否导致了放射治疗行程距离的变化以及放射治疗的协调地点尚不清楚。
我们分析了2018年至2020年国家癌症数据库中60个癌症部位的患者。分析人口统计学和临床变量以了解放射治疗行程距离的变化。我们将患者行程超过200英里的比例处于第99百分位或以上的机构指定为“目的地机构”。我们将“协调护理”定义为在癌症诊断所在的同一机构接受放射治疗。
我们评估了1,151,954名患者。大西洋中部各州接受治疗的患者比例下降超过1%。从居住地到放射治疗的平均行程距离从28.6英里降至25.9英里，行程超过50英里的比例从7.7%降至7.1%。在“目的地机构”，行程超过200英里的比例从2018年的29.3%降至2020年的24%。相比之下，在其他医院，行程超过200英里的比例从1.07%降至0.97%。2020年，居住在农村地区导致获得协调护理的几率较低（多变量优势比 = 0.89；95%置信区间，0.83 - 0.95）。
COVID疫情的第一年对美国放射治疗的地点产生了显著影响。
