Does Burden of Travel to Health Care Predict Survival among Chicagoans with Colorectal Cancer?
thesisposted on 18.10.2016, 00:00 by Emma E. Boylan
A study of the effect of travel burden on colorectal cancer prognosis was carried out in a retrospective cohort of Chicago residents diagnosed from 2006 to 2008. Potential travel between patients’ homes and diagnosing facilities were modeled and scores were generated for use in logistic and proportional hazards models to assess whether potential difficulty of traveling to care is associated with colorectal cancer stage at diagnosis and survival in urban residents. Burden of travel to cancer care is associated with colorectal cancer stage at diagnosis and colorectal cancer-specific survival. Increased travel burden score is associated with improved colorectal cancer-specific survival. Both transit and driving burden perform similarly in predicting stage at diagnosis. However, transit burden score is associated with colorectal cancer survival while driving burden score is not. Burden of travel to diagnosing facility is associated with increased odds of advanced stage at diagnosis in men, and decreased odds of advanced stage in women. Burden of travel to care does not interact with patient sex or race/ethnicity in predicting survival. Combining the components of travel burden into a single score improves model performance and coefficient interpretability. Although travel burden is associated with stage at colorectal cancer diagnosis and transit burden is associated with survival, increased burden of travel to health care does not appear to account for racial/ethnic disparities in colorectal cancer prognosis among urban residents.