Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study

Abstract

Background

Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes.

Methods

We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors.

Results

Of 10,228 patients surviving a median 5.1 months (IQR: 2.0–12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63–0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53–0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02–1.13) for 11–50 km, hazard ratio 1.13 (95% CI 1.04–1.23) for 51–100 km].

Conclusion

A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.

Funding

This work was supported by the Canadian Institutes of Health Research Partnerships for Health System Improvement (Grant number 154131).

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Correspondence to Julie Hallet.

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Conflict of interest

Julie Hallet has received speaking honoraria from Ipsen Biopharmaceuticals Canada and Novartis Oncology. Natalie G. Coburn receives salary support from Cancer Care Ontario as the Clinical Lead for Patient Reported Outcomes.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. For the conduct of this retrospective population-based study, informed consent was waived by the Research Ethics Board of Sunnybrook Health Sciences Centre.

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Yee, E.K., Coburn, N.G., Zuk, V. et al. Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study. Gastric Cancer (2021). https://doi.org/10.1007/s10120-021-01157-w

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Keywords

  • Esophagus
  • Stomach
  • Cancer
  • Outcomes
  • Geography