Evaluation of travel time to colorectal cancer care and survival: A cohort study using cancer registry data in Osaka Prefecture, Japan

IF 2 Q3 HEALTH POLICY & SERVICES

Journal of Cancer Policy Pub Date : 2025-03-12 DOI:10.1016/j.jcpo.2025.100573

Mari Kajiwara Saito , Shoko Wakamiya , Kayo Nakata , Mizuki Shimadzu Kato , Yoshihiro Kuwabara , Toshitaka Morishima , Isao Miyashiro

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Abstract

Background

Cancer care in Japan faces a major challenge in maintaining equity in access and efficiency. Care is provided on the basis of catchment area, referred to as a secondary medical area (SMA); at least one designated cancer care hospital (DCCH) is placed in every SMA. We aimed to evaluate travel time and net survival by SMA among patients diagnosed with colorectal cancer (CRC) in Osaka Prefecture, Japan.

Methods

We used cancer registry data for this cohort study and included patients diagnosed with CRC during 2013–2018. We evaluated equality in the utilisation of care by travel time between patients’ addresses and medical institutions for diagnosis or treatment in Osaka Prefecture. Travel time was compared by SMA of residence. We analysed which factors were associated with travel time using quantile regression. Efficiency was evaluated as un-standardised, age-standardised and stage-stratified three-year net survival by SMA of hospital for patients who received surgical resection.

Results

Among the 53,301 patients, the estimated median travel time was 27 (interquartile range 14 to 61, 90th percentile 82) minutes. Travel time varied between SMAs of residence by 20 minutes and types of hospital (prefectural DCCH versus non-DCCH) by 15 minutes at most. Regarding net survival, all SMA of hospital were within the 99.8 % control limits. However, around 40 % of hospitals had annual surgical volume below ten.

Conclusions

Travel time varied by SMA by 20 minutes at most. Although net survival was equalised across catchment areas, the current situation suggests an over-regionalisation of surgical care. The entire prefecture may need to reallocate resources to achieve higher efficiency.

Policy Summary

Reconfiguring cancer care might be inevitable to cut the waste of resource inputs, but access equity should also be considered when centralising care.

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出行时间对结直肠癌治疗和生存的评估：一项使用日本大阪府癌症登记数据的队列研究

背景：日本的癌症治疗面临着保持公平获取和效率的重大挑战。提供护理的基础是集水区，称为二级医疗区（SMA）；每个SMA中至少有一家指定的癌症护理医院。我们的目的是评估SMA在日本大阪府诊断为结直肠癌（CRC）患者中的旅行时间和净生存期。方法：我们使用癌症登记数据进行队列研究，纳入2013-2018年诊断为结直肠癌的患者。我们通过在大阪府的患者地址和医疗机构之间进行诊断或治疗的旅行时间来评估护理利用的公平性。出行时间用居住SMA进行比较。我们使用分位数回归分析了哪些因素与旅行时间相关。通过医院SMA对接受手术切除的患者进行非标准化、年龄标准化和分期分层的三年净生存率评估。结果：在53,301例患者中，估计中位旅行时间为27分钟（四分位数间距为14至61，第90百分位数为82）。不同居住地点的旅行时间相差20分钟，不同类型的医院（县儿童医院与非儿童医院）最多相差15分钟。净生存率方面，各医院SMA均在99.8%控制范围内。然而，大约40%的医院每年的手术量低于10例。结论：不同SMA的出行时间差异不超过20分钟。尽管净生存率在整个集水区是平等的，但目前的情况表明手术护理的过度区域化。整个县可能需要重新分配资源以实现更高的效率。政策摘要：为了减少资源投入的浪费，重新配置癌症治疗可能是不可避免的，但在集中治疗时也应考虑获取公平。(284字)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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