Henry Leonard R, Li Jun, Arciero Cletus, von Holzen Urs W, Schwarz Roderich, Jatoi Ismail
From the The Nancy N and JC Lewis Cancer and Research Pavilion at St Josephs Candler Healthsystem, Savannah, GA 31405.
Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN.
Ann Surg Open. 2023 Jan 30;4(1):e236. doi: 10.1097/AS9.0000000000000236. eCollection 2023 Mar.
Better cancer-related outcomes are associated with physicians and hospitals with higher case volume. This serves as an incentive to refer patients requiring complex cancer operations to large referral centers, which may require increased travel for patients. However, barriers exist for patients to travel for cancer care, some of which may be aggravated or alleviated by factors relating to the health of the national economy. This impact may be reflected in variability of travel distances for cancer operations over time particularly for complex operation such as pancreatectomy and esophagectomy compared with less complex resections such as those for breast cancer or melanoma.
We obtained the estimated travel distance for patients undergoing operations for cancer of the pancreas, esophagus, skin (melanoma), and breast from the National Cancer Database from 2004 to 2017 and correlated them with economic factors obtained from public sources. We then examined the impact of unemployment rates, gas prices, and inflation on travel distances regarding disadvantaged groups. Correlations were measured by the (rank-based, nonparametric) Spearman's correlation coefficient, and the corresponding value is obtained by the asymptotic distribution of the coefficient. A value of 0.05 equates to an absolute correlation value of 0.532. To adjust for multiple tests, a more restrictive value of 0.01 was also assessed, which equates to correlation coefficients of absolute value greater than 0.661.
There were 4,222,380 cases in the dataset, of which 1,781,056 remained after exclusion. The economic factors that were associated most strongly with the distance patients traveled for all cancer operation types were the labor force participation rate, personal savings, consumer price index, and changes in gasoline prices. Inflation and rising gasoline prices were often inversely related with travel distance in lower-income and less well-educated regions and African American patients.
Several macroeconomic factors correlate with the travel distance for operations, suggesting that the economic health of the nation may aggravate or alleviate the financial barriers to travel for cancer operations. Financially disadvantaged groups may be particularly vulnerable to changes in gasoline prices and inflation. Organizations serving these populations may need to increase patient support services during times of economic hardship to avoid the exacerbation of health care disparities.
癌症相关预后较好与处理病例数较多的医生和医院有关。这促使人们将需要进行复杂癌症手术的患者转诊至大型转诊中心，而这可能会增加患者的行程。然而，患者前往接受癌症治疗存在障碍，其中一些障碍可能会因国民经济健康相关因素而加剧或缓解。这种影响可能体现在癌症手术行程距离随时间的变化上，特别是与乳腺癌或黑色素瘤等不太复杂的手术相比，胰十二指肠切除术和食管切除术等复杂手术更是如此。
我们从国家癌症数据库中获取了2004年至2017年接受胰腺癌、食管癌、皮肤癌（黑色素瘤）和乳腺癌手术患者的估计行程距离，并将其与从公共来源获取的经济因素相关联。然后，我们研究了失业率、汽油价格和通货膨胀对弱势群体行程距离的影响。相关性通过（基于秩的非参数）斯皮尔曼相关系数进行测量，相应的 值通过该系数的渐近分布获得。 值为0.05相当于绝对相关值为0.532。为了校正多重检验，还评估了更严格的 值0.01，其相当于绝对值大于0.661的相关系数。
数据集中有4222380例病例，排除后剩下1781056例。与所有癌症手术类型患者行程距离最密切相关的经济因素是劳动力参与率、个人储蓄、消费者价格指数和汽油价格变化。在低收入、受教育程度较低的地区以及非裔美国患者中，通货膨胀和汽油价格上涨通常与行程距离呈负相关。
几个宏观经济因素与手术行程距离相关，这表明国家的经济健康状况可能会加剧或缓解癌症手术行程的经济障碍。经济上处于不利地位的群体可能特别容易受到汽油价格和通货膨胀变化的影响。为这些人群服务的组织可能需要在经济困难时期增加患者支持服务，以避免医疗保健差距加剧。
