Cervical cancer treatment initiation and survival: The role of residential proximity to cancer care

Objective To examine the role of driving time to cancer care facilities on days to cancer treatment initiation and cause-specific survival for cervical cancer patients. Methods A retrospective cohort analysis of patients diagnosed with invasive cervical cancer during 2001–2016, using South Carolina Central Cancer Registry data linked to vital records. Kaplan-Meier survival curves and Cox proportional hazards models were used to examine the association of driving times to both a patient's nearest and actual cancer treatment initiation facility with cause-specific survival and time to treatment initiation. Results Of 2518 eligible patients, median cause-specific survival was 49 months (interquartile, 17–116) and time to cancer treatment initiation was 21 days (interquartile, 0–40). Compared to patients living within 15 min of the nearest cancer provider, those living more than 30 min away were less likely to receive initial treatment at teaching hospitals, Joint Commission accredited facilities, and/or Commission on Cancer accredited facilities. After controlling for patient, clinical, and provider characteristics, no significant associations existed between driving times to the nearest cancer provider and survival/time to treatment. When examining driving times to treatment initiation (rather than simply nearest) provider, patients who traveled farther than 30 min to their actual providers had delayed initiation of cancer treatment (hazard ratio, 0.81; 95% confidence interval, 0.73–0.90), including surgery (0.82; 95% CI, 0.72–0.92) and radiotherapy (0.82, 95% CI, 0.72–0.94). Traveling farther than 30 min to the first treating provider was not associated with worse cause-specific survival. Conclusions For cervical cancer patients, driving time to chosen treatment providers, but not to the nearest cancer care provider, was associated with prolonged time to treatment initiation. Neither was associated with survival.