How Far Are Lung Cancer Patients Willing to Travel for Treatment?

Patients with non-small cell lung cancer (NSCLC) value care and treatment close to their homes, according to findings from recent surveys. Zoya Mohammad, MD/MPH candidate, a medical student at the University of Texas, presented the results at the Southern Thoracic Surgical Association 65th Annual Meeting & Exhibition.

NSCLC claims the lives of more Americans than breast cancer, prostate cancer, and colon cancer combined, Mohammad said. “While we have learned more about the multifactorial genomic, host, and environmental factors that shape the treatment and prognosis of patients with lung cancer, there are still issues that impede providing a quality of care.”

Specialty providers tend to work in metropolitan areas, Mohammad explained, therefore hindering accessibility for patients in other locations. This inequality has created a need for “specialty outreach clinics” to afford patients the opportunity to be evaluated closer to home.

These clinics “give opportunities for patients with suspected pulmonary malignancies to be evaluated closer to their homes,” she said, but research on the impacts of these clinics in the United States remains limited.

The researchers sought to evaluate the need for specialty clinic access outside major medical facilities, as well as gather information on the preferences of patients with lung cancer who may benefit from these clinics. The researchers hypothesized that patients would prefer to be closer to home, but that distance sensitivity may vary depending on the services rendered. They predicted that patients would be more willing to travel for single events, such as surgery, versus recurrent treatments like radiation and chemotherapy.

The surveys were administered to patients of a single thoracic surgeon at a clinic about 20 miles from the University of Texas MD Anderson Cancer Center. Initial clinic visit surveys were analyzed. Surveys with missing responses or answers that could not be evaluated were excluded.

Responses from 69 patients (58% female; mean age = 69 years) were included in final analysis. Most patients were former or current smokers. The median distance patients traveled to the clinic was 43.5 miles. When asked, “How important is it to receive lung cancer care close to home?” nearly half (48.5%) said “very,” while 39.7% said “moderately.” Only 11.8% of respondents said “not at all.” When asked about the perceived benefits of an outreach clinic, physician expertise was the most popular answer (75.4%), followed by proximity to home (40.6%). Reduced traffic and free parking were ranked similarly (26.1% and 24.6%, respectively.)

Patients who traveled ≥50 miles were more likely to consider physician expertise as a benefit of the clinic (84.4% vs 69.7%; P=0.160) and were more willing to travel ≥100 miles for surgery (71.0% vs 26.7%; P=0.001) or consultation with a surgeon (71.0% vs 25.8%; P<0.001). Overall, patients were willing to travel farther for surgery than for consultations or treatments. Patients who wanted expert physicians were more likely to say they would travel to a main medical campus to undergo radiation therapy (75.5% vs 42.9%; P=0.047) or consult with medical oncologists (77.6% vs 57.1%; P=0.174), radiation oncologists (77.6% vs 50.0%; P = 0.090), and surgeons (83.7% vs 64.3%; P=0.141). Patients who valued care close to home were less willing to travel ≥100 miles to consult with surgeons (33.3% vs 65.6%; P=0.011), medical oncologists (33.3% vs 65.6%; P=0.011), and radiation oncologists (33.3% vs 64.5%; P=0.015). They were also less likely to travel ≥100 miles for treatment (surgery = 33.3% vs 65.6%; P=0.011; chemotherapy = 36.7% vs 60.7%; P=0.067; radiotherapy = 33.3% vs 64.3%; P=0.018).

“The most frequently cited benefits were access to physician expertise and proximity to home,” Mohammad said. “Patients were willing to travel greater distances for surgery than for consultation or for recurrent treatments such as chemotherapy or radiotherapy. Nearly half of patients placed high value on undergoing treatment close to home and are sensitive to the distance required to travel.”

The single-center nature of this study is a limitation. Outreach also consisted primarily of patients with insurance. Further investigation needs to evaluate data from other institutions, as well as data from different patient demographics, Mohammad said. Additionally, the survey only included data from patients who showed up to their appointments.

“A substantial subset of [patients with] NSCLC are sensitive to distance required to travel for consultation or treatment. Specialty outreach clinics may provide benefit in a setting of initial consultations, preoperative evaluation, and postoperative care,” she concluded.