National Economic Conditions May Impact the Financial Barriers to Travel for Cancer Operations
Background:. Better cancer-related outcomes are associated with physicians and hospitals with higher case volume. This serves as an incentive to refer patients requiring complex cancer operations to large referral centers, which may require increased travel for patients. However, barriers exist for...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2023-03-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000236 |
| _version_ | 1797732809063792640 |
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| author | Leonard R. Henry, MD, MBA, FACS Jun Li, PhD Cletus Arciero, MD, FACS Urs W. von Holzen, MD, MBA, FACS Roderich Schwarz, MD, PhD, FACS Ismail Jatoi, MD, PhD, FACS |
| author_facet | Leonard R. Henry, MD, MBA, FACS Jun Li, PhD Cletus Arciero, MD, FACS Urs W. von Holzen, MD, MBA, FACS Roderich Schwarz, MD, PhD, FACS Ismail Jatoi, MD, PhD, FACS |
| author_sort | Leonard R. Henry, MD, MBA, FACS |
| collection | DOAJ |
| description | Background:. Better cancer-related outcomes are associated with physicians and hospitals with higher case volume. This serves as an incentive to refer patients requiring complex cancer operations to large referral centers, which may require increased travel for patients. However, barriers exist for patients to travel for cancer care, some of which may be aggravated or alleviated by factors relating to the health of the national economy. This impact may be reflected in variability of travel distances for cancer operations over time particularly for complex operation such as pancreatectomy and esophagectomy compared with less complex resections such as those for breast cancer or melanoma.
Methods:. We obtained the estimated travel distance for patients undergoing operations for cancer of the pancreas, esophagus, skin (melanoma), and breast from the National Cancer Database from 2004 to 2017 and correlated them with economic factors obtained from public sources. We then examined the impact of unemployment rates, gas prices, and inflation on travel distances regarding disadvantaged groups. Correlations were measured by the (rank-based, nonparametric) Spearman’s correlation coefficient, and the corresponding P value is obtained by the asymptotic distribution of the coefficient. A P value of 0.05 equates to an absolute correlation value of 0.532. To adjust for multiple tests, a more restrictive P value of 0.01 was also assessed, which equates to correlation coefficients of absolute value greater than 0.661.
Results:. There were 4,222,380 cases in the dataset, of which 1,781,056 remained after exclusion. The economic factors that were associated most strongly with the distance patients traveled for all cancer operation types were the labor force participation rate, personal savings, consumer price index, and changes in gasoline prices. Inflation and rising gasoline prices were often inversely related with travel distance in lower-income and less well-educated regions and African American patients.
Conclusions:. Several macroeconomic factors correlate with the travel distance for operations, suggesting that the economic health of the nation may aggravate or alleviate the financial barriers to travel for cancer operations. Financially disadvantaged groups may be particularly vulnerable to changes in gasoline prices and inflation. Organizations serving these populations may need to increase patient support services during times of economic hardship to avoid the exacerbation of health care disparities. |
| first_indexed | 2024-03-12T12:18:58Z |
| format | Article |
| id | doaj.art-a813eb5f1ab140c1bbb38310dad74c1f |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:18:58Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-a813eb5f1ab140c1bbb38310dad74c1f2023-08-30T06:10:48ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932023-03-0141e23610.1097/AS9.0000000000000236202303000-00018National Economic Conditions May Impact the Financial Barriers to Travel for Cancer OperationsLeonard R. Henry, MD, MBA, FACS0Jun Li, PhD1Cletus Arciero, MD, FACS2Urs W. von Holzen, MD, MBA, FACS3Roderich Schwarz, MD, PhD, FACS4Ismail Jatoi, MD, PhD, FACS5From the * The Nancy N and JC Lewis Cancer and Research Pavilion at St Josephs Candler Healthsystem, Savannah, GA 31405† Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN‡ Division of Surgical Oncology, Emory University, Atlanta, GA§ Goshen Center for Cancer Care, Goshen, IN‖ Division of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY¶ Division of Surgical Oncology, UT San Antonio, San Antonio, TX.Background:. Better cancer-related outcomes are associated with physicians and hospitals with higher case volume. This serves as an incentive to refer patients requiring complex cancer operations to large referral centers, which may require increased travel for patients. However, barriers exist for patients to travel for cancer care, some of which may be aggravated or alleviated by factors relating to the health of the national economy. This impact may be reflected in variability of travel distances for cancer operations over time particularly for complex operation such as pancreatectomy and esophagectomy compared with less complex resections such as those for breast cancer or melanoma. Methods:. We obtained the estimated travel distance for patients undergoing operations for cancer of the pancreas, esophagus, skin (melanoma), and breast from the National Cancer Database from 2004 to 2017 and correlated them with economic factors obtained from public sources. We then examined the impact of unemployment rates, gas prices, and inflation on travel distances regarding disadvantaged groups. Correlations were measured by the (rank-based, nonparametric) Spearman’s correlation coefficient, and the corresponding P value is obtained by the asymptotic distribution of the coefficient. A P value of 0.05 equates to an absolute correlation value of 0.532. To adjust for multiple tests, a more restrictive P value of 0.01 was also assessed, which equates to correlation coefficients of absolute value greater than 0.661. Results:. There were 4,222,380 cases in the dataset, of which 1,781,056 remained after exclusion. The economic factors that were associated most strongly with the distance patients traveled for all cancer operation types were the labor force participation rate, personal savings, consumer price index, and changes in gasoline prices. Inflation and rising gasoline prices were often inversely related with travel distance in lower-income and less well-educated regions and African American patients. Conclusions:. Several macroeconomic factors correlate with the travel distance for operations, suggesting that the economic health of the nation may aggravate or alleviate the financial barriers to travel for cancer operations. Financially disadvantaged groups may be particularly vulnerable to changes in gasoline prices and inflation. Organizations serving these populations may need to increase patient support services during times of economic hardship to avoid the exacerbation of health care disparities.http://journals.lww.com/10.1097/AS9.0000000000000236 |
| spellingShingle | Leonard R. Henry, MD, MBA, FACS Jun Li, PhD Cletus Arciero, MD, FACS Urs W. von Holzen, MD, MBA, FACS Roderich Schwarz, MD, PhD, FACS Ismail Jatoi, MD, PhD, FACS National Economic Conditions May Impact the Financial Barriers to Travel for Cancer Operations Annals of Surgery Open |
| title | National Economic Conditions May Impact the Financial Barriers to Travel for Cancer Operations |
| title_full | National Economic Conditions May Impact the Financial Barriers to Travel for Cancer Operations |
| title_fullStr | National Economic Conditions May Impact the Financial Barriers to Travel for Cancer Operations |
| title_full_unstemmed | National Economic Conditions May Impact the Financial Barriers to Travel for Cancer Operations |
| title_short | National Economic Conditions May Impact the Financial Barriers to Travel for Cancer Operations |
| title_sort | national economic conditions may impact the financial barriers to travel for cancer operations |
| url | http://journals.lww.com/10.1097/AS9.0000000000000236 |
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