A. K. Smith1, N. Shara2,4, A. Zeymo2, R. Estes2, K. Harris1,2, L. Johnson1,3, W. Al-Refaie1,3 1MedStar Georgetown Surgical Outcomes Research Center,Surgery,Washington, DC, USA 2MedStar Health Research Institute,Biostatistics,Hyatsville, MARYLAND, USA 3Georgetown University Medical Center,Lombardi Comprehensive Cancer Center,Washington, DC, USA 4Georgetown University Medical Center,Georgetown-Howard Universities Center For Clinical And Translational Sciences,Washington, DC, USA
Introduction: Regionalization of complex surgeries has led patients to travel longer distances for surgical care. This may be burdensome to vulnerable populations, including older adults and ethnic/racial minorities, who may lack the means to travel long distances. To date, little is known about travel patterns of patients undergoing major cancer surgery in a regionalized care setting. To inform this issue, we sought to map travel patterns among these vulnerable populations who received major cancer surgery within a large, regionalized healthcare system.
Methods: We identified 6,120 patients who underwent lung, esophageal, gastric, liver, pancreatic and colorectal resections from 2002 to 2014 within our large and diverse multi-hospital healthcare system. Patients’ age, race/ethnicity and insurance status were extracted from our electronic health records. We then used Geographic Information System (GIS) software in R to map the distribution of patients’ addresses based on cancer surgery type and vulnerability characteristics. We used visual inspection to assess the distribution and magnitude of travel distances between cancer surgery and each patient characteristic.
Results: 48.2% were non-white, 49.9% were >65 years old and 54.9% of patients had private insurance. Results from the maps showed that for all six oncologic resections, patients over 50 years and whites tend to travel further than younger patients and other racial/ethnic groups for surgery (see figure).Conversely, mapping patients by insurance status did not demonstrate similar geospatial patterns.
Conclusion: These maps offer a preliminary understanding into variations of geospatial travel patterns to receive major cancer surgery in a regionalized setting. Future research should focus on quantifying differences in travel distances and its impact on timely delivery of surgical care.
