GME Patient Safety Quality and Innovation Symposium

Background:  

Due to uneven geographic distribution of health care infrastructure, long distance travel is a reality of cancer care for many patients. Patients travel significant distances to access tertiary academic centers or receive multidisciplinary care¹. Outcomes for patients have been mixed. A 2021 study of HCC patients undergoing liver resection showed living >50 miles from high volume tertiary academic centers was associated with worse overall survival².

However, a subsequent NationalCancer Database (NCD) study demonstrated that HCC patients who travel >30 km/18.6 mi were more likely to have higher rates of locoregional/surgical treatment, academic center care, and improved overall survival. Authors reflected this population may be highly motivated and financially able to seek distance care³. Further outcomes research is needed, especially for HCC patients receiving longitudinal multidisciplinary therapy.  

UC San Diego (UCSD) services a large catchment area for cancer patients. Our goal is to better understand the demographics of patients with HCC at UCSD, identify protective factors that enable patients to travel long distances, and use this information to tailor care. 

Description:

We are conducting a retrospective review of 381 patients with HCC who received care at UCSD, stratified by travel distance. Distance travelled was measured by Google Maps from treating facility to home zip code.  Similar to prior studies^2,4, distance was stratified at 50 miles and 100 miles. Correlation is planned with patient, disease, and treatment-specific factors, as well as primary outcomes of clinical trial enrollment and overall survival. 

Lessons Learned or Expected Outcomes: 

Of the 381 patients identified with HCC, 265 received systemic therapy at UCSD. Travel ranged from 1.9 to 308 miles for care. Excluding 4 outlier patients who traveled 164-308 miles, the remaining 261 patients are displayed in the figure below. 198 patients, (74.7%) live within 50 miles, 25 patients (9.4%) live between 50-100 miles, and 42 patients (15.8%) live over 100 miles away. 

Additional data analysis is underway.  

Roughly a quarter (25.2%) of patients with HCC travel over 50 miles to receive care at UCSD. Understanding the factors that make this possible for patients can guide institutional support programs and outreach.  

Recommendations:  

Next steps include completing our retrospective patient chart review. If factors like caregiver presence, language interpreter availability, or household support are protective for distance travel, these may help guide support programs.