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06.02.2021 | Original Article

Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study

verfasst von: Elliott K. Yee, Natalie G. Coburn, Victoria Zuk, Laura E. Davis, Alyson L. Mahar, Ying Liu, Vaibhav Gupta, Gail Darling, Julie Hallet

Erschienen in: Gastric Cancer | Ausgabe 4/2021

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Abstract

Background

Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes.

Methods

We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors.

Results

Of 10,228 patients surviving a median 5.1 months (IQR: 2.0–12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63–0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53–0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02–1.13) for 11–50 km, hazard ratio 1.13 (95% CI 1.04–1.23) for 51–100 km].

Conclusion

A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care.

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Titel: Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study
verfasst von: Elliott K. Yee
Natalie G. Coburn
Victoria Zuk
Laura E. Davis
Alyson L. Mahar
Ying Liu
Vaibhav Gupta
Gail Darling
Julie Hallet
Publikationsdatum: 06.02.2021
Verlag: Springer Singapore
Erschienen in: Gastric Cancer / Ausgabe 4/2021
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI: https://doi.org/10.1007/s10120-021-01157-w

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