title: Geography and the burden of care in pediatric cancers.
abstract: BACKGROUND
  Childhood cancers typically require rigorous treatment at specialized centers in urban areas, which can create substantial challenges for families residing in remote communities. We evaluated the impact of residence and travel time on the burden of care for families of childhood cancer patients.
  
  
  METHODS
  We conducted a cross-sectional, self-administered survey of 354 caregivers of pediatric cancer patients at a children's hospital serving a seven state area. Measures included the impact of cancer treatment on relocation, employment, schooling, and finances. We evaluated these domains by rural/urban residence and travel time (>1 hour and >2 hours) to the hospital in multivariable regression models.
  
  
  RESULTS
  Of the 29% of caregivers who reported moving residences as their child was diagnosed, 33% reported that the move was due to their child's cancer. Rural and remote (e.g., >1 hour travel time) caregivers missed more days of work during the first month after diagnosis than did urban and local caregivers, however, these differences did not persist over the first 6 months of therapy. One-third of caregivers reported quitting or changing jobs as a direct result of their child being diagnosed with cancer. Rural respondents had greater out-of-pocket travel expenses and reported a significantly greater perceived financial burden. Rural patients missed more school days and were at an increased risk of having to repeat a grade.
  
  
  CONCLUSIONS
  Childhood cancer has an appreciable impact on the lives of patients and caregivers. The burden is greater for those living far from a treatment center.
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah; Primary Children's Medical Center, Salt Lake City, Utah.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Fluchel
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
authors.forename: Julia
authors.initials: J
authors.lastname: Bodson
authors.forename: Carol
authors.initials: C
authors.lastname: Sweeney
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Edwards
authors.forename: Qian
authors.initials: Q
authors.lastname: Ding
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Kinney
mesh_terms: D017028:Caregivers; D002648:Child; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000191:economics*; D010353:Patient Education as Topic; D014195:Travel
keywords: burden of care; disparities; pediatric oncology; rural