Miho Akabane, Abdullah Altaf, Jun Kawashima, Yuki Imaoka, Timothy M Pawlik
{"title":"Travel Distance and Insurance Status: Association With Treatment Access and Survival Among Patients With Hepatocellular Carcinoma.","authors":"Miho Akabane, Abdullah Altaf, Jun Kawashima, Yuki Imaoka, Timothy M Pawlik","doi":"10.1002/jso.70047","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Travel distance to healthcare facilities can affect hepatocellular carcinoma (HCC) treatment access, but its association with treatment rates, delays, and overall survival (OS) remains unclear. We evaluated the association of travel distance and insurance status with treatment receipt, delays, and OS.</p><p><strong>Methods: </strong>Patients diagnosed with HCC (2000-2019) were identified from National Cancer Database. Travel distance was categorized as Near (0-10 km), Medium (10-30 km), and Far (> 30 km). Multivariable logistic regression and Cox proportional hazards models were performed.</p><p><strong>Results: </strong>Among 191,742 patients, 47.9% had Medicare, 29.7% Private insurance, 14.9% Medicaid, and 5.5% were uninsured. Treatment rates increased with distance (Near: 40.9%, Medium: 43.7%, Far: 48.4%; p < 0.001), as did treatment at academic centers (Near: 43.3%, Medium: 52.0%, Far: 67.0%; p < 0.001). Private insurance was more common among individuals traveling farther (p < 0.001). Medicaid and uninsured patients were less likely to receive surgical/local treatment than Private or Medicare patients (p < 0.001). Distance (Medium vs. Near: OR 1.155; Far vs. Near: OR 1.440) and insurance (Private vs. Uninsured: OR 2.457; Medicare: OR 2.262; Medicaid: OR1.549) were associated with treatment receipt. Longer distances were associated with higher odds of treatment delays (Medium vs. Near: OR 1.116; Far vs. Near: OR 1.267). Five year OS was lowest in Near (18.0%) and highest in Far (27.6%) distance cohorts. On multivariable analysis, facility type (Community: HR 1.819; Comprehensive: HR 1.409; Integrated: HR 1.151 vs. Academic) and insurance (Private: HR 0.657; Medicare: HR 0.683; Medicaid: HR 0.809 vs. Uninsured) remained associated with OS.</p><p><strong>Conclusions: </strong>Travel distance and insurance status influenced HCC treatment access. Traveling farther resulted in treatment at academic centers and better OS but increased delays. Private insurance improved access, yet disparities persist.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.70047","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Travel distance to healthcare facilities can affect hepatocellular carcinoma (HCC) treatment access, but its association with treatment rates, delays, and overall survival (OS) remains unclear. We evaluated the association of travel distance and insurance status with treatment receipt, delays, and OS.
Methods: Patients diagnosed with HCC (2000-2019) were identified from National Cancer Database. Travel distance was categorized as Near (0-10 km), Medium (10-30 km), and Far (> 30 km). Multivariable logistic regression and Cox proportional hazards models were performed.
Results: Among 191,742 patients, 47.9% had Medicare, 29.7% Private insurance, 14.9% Medicaid, and 5.5% were uninsured. Treatment rates increased with distance (Near: 40.9%, Medium: 43.7%, Far: 48.4%; p < 0.001), as did treatment at academic centers (Near: 43.3%, Medium: 52.0%, Far: 67.0%; p < 0.001). Private insurance was more common among individuals traveling farther (p < 0.001). Medicaid and uninsured patients were less likely to receive surgical/local treatment than Private or Medicare patients (p < 0.001). Distance (Medium vs. Near: OR 1.155; Far vs. Near: OR 1.440) and insurance (Private vs. Uninsured: OR 2.457; Medicare: OR 2.262; Medicaid: OR1.549) were associated with treatment receipt. Longer distances were associated with higher odds of treatment delays (Medium vs. Near: OR 1.116; Far vs. Near: OR 1.267). Five year OS was lowest in Near (18.0%) and highest in Far (27.6%) distance cohorts. On multivariable analysis, facility type (Community: HR 1.819; Comprehensive: HR 1.409; Integrated: HR 1.151 vs. Academic) and insurance (Private: HR 0.657; Medicare: HR 0.683; Medicaid: HR 0.809 vs. Uninsured) remained associated with OS.
Conclusions: Travel distance and insurance status influenced HCC treatment access. Traveling farther resulted in treatment at academic centers and better OS but increased delays. Private insurance improved access, yet disparities persist.
期刊介绍：
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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