title: Effect of travel distance and time to radiotherapy on likelihood of receiving mastectomy.
abstract: BACKGROUND
  Breast-conserving surgery (BCS) followed by adjuvant radiation therapy (RT) is the standard of care for women with early-stage breast cancer as an alternative to mastectomy. The purpose of this study was to examine the relationship between receipt of mastectomy and travel distance and time to RT facility in New Jersey (NJ).
  
  
  METHODS
  Data were collected from a cohort of 634 NJ women diagnosed with early-stage breast cancer. In patients receiving RT, the precise RT facility was used, whereas in patients not receiving RT, surgeons were contacted to determine the location of RT referral. Travel distance and time to RT facility from the patients' residential address were modeled separately using multiple binomial regression to examine their association with choice of surgery while adjusting for clinical and sociodemographic factors.
  
  
  RESULTS
  Overall, 58.5 % patients underwent BCS with median travel distance to the radiation facility of 4.8 miles (vs. 6.6 miles for mastectomy) and median travel time of 12.0 min (vs. 15.0 min for mastectomy). Patients residing > 9.2 miles compared with ≤ 9.2 miles from radiation facility were 44 % more likely to receive mastectomy. Additionally, patients requiring > 19 min compared with ≤ 19 min of travel time were 36 % more likely to receive mastectomy.
  
  
  CONCLUSIONS
  These data found that travel distance and time from RT facility act as barriers to undergoing BCS in women with early-stage breast cancer. Despite being in an urban region, a significant number of women in NJ with early-stage breast cancer did not receive BCS.
authors.affiliation: Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA, goyalsh@rutgers.edu.
authors.forename: Sharad
authors.initials: S
authors.lastname: Goyal
authors.forename: Sheenu
authors.initials: S
authors.lastname: Chandwani
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.forename: Kitaw
authors.initials: K
authors.lastname: Demissie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult