Going the Distance: Travel Time's Influence on Radiation Treatment for NH Prostate Cancer Patients
Our findings are encouraging regarding access to the range of prostate cancer treatment options in New Hampshire.Elias Hyams, MD
In the largely rural state of New Hampshire, there is a concern that potential longer travel times to radiation centers may discourage men with prostate cancer from pursuing daily external beam radiation therapy (EBRT) treatment, which can often last two months or more. A new Dartmouth study led by Urologist Elias Hyams, MD, Assistant Professor of Surgery at Dartmouth’s Geisel School of Medicine shows that this concern may not be necessary. “We were seeking to understand whether travel time to a radiation center affected decisions to proceed with EBRT vs. surgery for treatment of localized prostate cancer” Hyams explains. “We found that longer travel time to a radiation facility was not associated with lower utilization of EBRT compared to single trip therapies, primarily surgery. Most men had reasonable geographic access to a radiation center (87% within a 30-minute drive), likely due to population density in the southern portion of the state.” Their study, “Does Travel Time to a Radiation Facility Impact Patient Decision-Making Regarding Treatment for Prostate Cancer? A Study of the New Hampshire State Cancer Registry” was recently published in The Journal of Rural Health.
Using New Hampshire State Cancer Registry data on almost 5,000 patients, Hyams’ study is unique in investigating, within a rural state, whether logistical challenges to EBRT influence treatment decisions. Patients were categorized by age, risk category, year of treatment, marital status, season of diagnosis, urban/rural residence, and driving time to the nearest radiation facility. Treatment decisions were sectioned into those requiring multiple trips (such as daily EBRT) or a single trip (such as surgery or brachytherapy). The study finds that time to the nearest radiation facility was not associated with treatment decisions, however, higher risk category, older age, married status, and winter diagnosis were associated with lower utilization of radiation therapy.
“This study improves our understanding of factors that do and do not affect decision making for prostate cancer treatment” says Hyams. “EBRT and surgery are considered similar in effectiveness for localized prostate cancer, but one or the other may be preferred by patients based on side-effect profile. Our findings are encouraging regarding access to the range of prostate cancer treatment options in New Hampshire.”
Researchers are beginning to examine this question outside of the Northeast, for instance in the Midwest, where travel times may be longer and impactful on treatment decisions. For some men, travel time will still be a deterrent to EBRT—newer treatment regimens, while still being studied, may offer shorter duration of treatment, which may help to reduce the logistical burden of treatment for these men. “We work hard to counsel men with newly diagnosed prostate cancer on their options, from observation to surgical removal to different forms of radiation therapy” concludes Hyams. “It’s important that we continue to explore how non-medical factors may be influencing treatment decisions, and work to ensure full access to treatment options.”
This research was supported by The Norris Cotton Cancer Center's GeoSpatial Resource, which is funded by a Cancer Center Support Grant. This project was funded in part by the Centers for Disease Control, Prevention's National Program of Cancer Registries, cooperative agreement, and awards to the New Hampshire Department of Health and Human Services, Division of Public Health Services, Bureau of Public Health Statistics and Informatics, Office of Health Statistics and Data Management.