title: Travel patterns of cancer surgery patients in a regionalized system.
abstract: BACKGROUND
  Regionalization of complex surgeries has increased patient travel distances possibly leaving a substantial burden on those at risk for poorer surgical outcomes. To date, little is known about travel patterns of cancer surgery patients in regionalized settings. To inform this issue, we sought to assess travel patterns of those undergoing a major cancer surgery within a regionalized system.
  
  
  METHODS
  We identified 4733 patients who underwent lung, esophageal, gastric, liver, pancreatic, and colorectal resections from 2002-2014 within a multihospital system in the Mid-Atlantic region of the United States. Patient age, race and/or ethnicity, and insurance status were extracted from electronic health records. We used Geographical Information System capabilities in R software to estimate travel distance and map patient addresses based on cancer surgery type and these characteristics. We used visual inspection, analysis of variance, and interaction analyses to assess the distribution of travel distances between patient populations.
  
  
  RESULTS
  A total of 48.2% of patients were non-white, 49.9% were aged >65 y, and 54.9% had private insurance. Increased travel distance was associated with decreasing age and those undergoing pancreatic and esophageal resections. Also, black patients tend to travel shorter distances than other racial and/or ethnic groups.
  
  
  CONCLUSIONS
  These maps offer a preliminary understanding into variations of geospatial travel patterns among patients receiving major cancer surgery in a Mid-Atlantic regionalized setting. Future research should focus on the impact of regionalization on timely delivery of surgical care and other quality metrics.
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Georgetown University Hospital, Washington, DC; Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, MD.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Smith
authors.affiliation: MedStar-Georgetown Surgical Outcomes Research Center, Georgetown University Hospital, Washington, DC; Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, MD; The Georgetown-Howard University Center for Clinical and Translational Science, Washington, DC.
authors.forename: Nawar M
authors.initials: NM
authors.lastname: Shara
authors.affiliation: Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, MD.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zeymo
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Georgetown University Hospital, Washington, DC; Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, MD.
authors.forename: Katherine
authors.initials: K
authors.lastname: Harris
authors.affiliation: Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, MD.
authors.forename: Randy
authors.initials: R
authors.lastname: Estes
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Georgetown University Hospital, Washington, DC; Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, MD; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
authors.forename: Lynt B
authors.initials: LB
authors.lastname: Johnson
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Georgetown University Hospital, Washington, DC; Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, MD; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC. Electronic address: Waddah.B.Al-Refaie@gunet.georgetown.edu.
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D005260:Female; D040362:Geographic Information Systems; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008377:Maps as Topic; D008873:Mid-Atlantic Region; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D012041:Regional Medical Programs; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Disparities; Geographical information systems; Major cancer surgery; Travel