title: Distance as a Barrier to Cancer Diagnosis and Treatment: Review of the Literature.
abstract: The burden of travel from a patient's residence to health care providers is an important issue that can influence access to diagnosis and treatment of cancer. Although several studies have shown that the travel burden can result in delays in diagnosis and treatment of many common cancers, its role appears underestimated in the treatment of patients in clinical practice. Therefore, we performed a review of the published data on the role of travel burden influencing four items: delay of diagnosis, adequate treatment of cancer, outcome, and quality of life of cancer patients. Forty-seven studies published up to December 2014 were initially identified. Twenty studies were excluded because they did not regard specifically the four items of our review. Twenty-seven studies formed the basis of our study and involved 716,153 patients. The associations between travel burden and (a) cancer stage at diagnosis (12 studies), (b) appropriate treatment (8 studies), (c) outcome (4 studies), and (d) quality of life (1 study) are reported. In addition, in two studies, the relation between travel burden and compliance with treatment was examined. The results of our review show that increasing travel requirements are associated with more advanced disease at diagnosis, inappropriate treatment, a worse prognosis, and a worse quality of life. These results suggest that clinical oncologists should remember the specific travel burden problem for cancer patients, who often need health care services every week or every month for many years.
authors.affiliation: Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Ambroggi
authors.affiliation: Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Biasini
authors.affiliation: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Del Giovane
authors.affiliation: Department of Medicine, G. da Saliceto Hospital, Piacenza, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Fornari
authors.affiliation: Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy l.cavanna@ausl.pc.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cavanna
mesh_terms: D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Cancer diagnosis and treatment; Cancer patients; Distance from hospitals; Outcome; Quality of life; Travel burden