Nationwide changes in radiation oncology travel and location of care before and during the COVID-19 pandemic

Purpose@#Patients with cancer are particularly vulnerable to coronavirus disease (COVID). Transportation barriers made travel to obtain medical care more difficult during the pandemic. Whether these factors led to changes in the distance traveled for radiotherapy and the coordinated location of radiation treatment is unknown. @*Materials and Methods@#We analyzed patients across 60 cancer sites in the National Cancer Database from 2018 to 2020. Demographic and clinical variables were analyzed for changes in distance traveled for radiotherapy. We designated the facilities in the 99th percentile or above in terms of the proportion of patients who traveled more than 200 miles as “destination facilities.” We defined “coordinated care” as undergoing radiotherapy at the same facility where the cancer was diagnosed. @*Results@#We evaluated 1,151,954 patients. There was a greater than 1% decrease in the proportion of patients treated in the Mid-Atlantic States. Mean distance traveled from place of residence to radiation treatment decreased from 28.6 to 25.9 miles, and the proportion traveling greater than 50 miles decreased from 7.7% to 7.1%. At “destination facilities,” the proportion traveling more than 200 miles decreased from 29.3% in 2018 to 24% in 2020. In comparison, at the other hospitals, the proportion traveling more than 200 miles decreased from 1.07% to 0.97%. In 2020, residing in a rural area resulted in a lower odds of having coordinated care (multivariable odds ratio = 0.89; 95% confidence interval, 0.83–0.95). @*Conclusion@#The first year of the COVID pandemic measurably impacted the location of U.S. radiation therapy treatment.

global cancer divide: relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries

Cancer continues to rise as a contributor to premature death in the developing world. Despite this, little is known about whether cancer outcomes are related to a country's income level, and what aspects of national healthcare systems are associated with improved cancer outcomes. The most recent estimates of cancer incidence and mortality were used to calculate mortality-to-incidence ratio [MIR] for the 85 countries with reliable data. Countries were categorized according to high-income [Gross Domestic Product [GDP] > [dollar sign]15,000] or middle/low-income [GDP < [dollar sign]15,000], and a multivariate linear regression model was used to determine the association between healthcare system indicators and cancer MIR. Indicators study included per capita GDP, overall total healthcare expenditure [THE], THE as a proportion of GDP, total external beam radiotherapy devices [TEBD] per capita, physician density, and the year 2000 WHO healthcare system rankings. Cancer MIR in high-income countries [0.47] was significantly lower than that of middle/low-income countries [0.64], with a p < 0.001. In high-income countries, GDP, health expenditure and TEBD showed significant inverse correlations with overall cancer MIR. A [dollar sign]3040 increase in GDP [p = 0.004], a [dollar sign]379 increase in THE [p < 0.001], or an increase of 0.59 TEBD per 100,000 population [p = 0.027] were all associated with a 0.01 decrease in cancer MIR. In middle/low-income countries, only WHO scores correlated with decreased cancer MIR [p = 0.022]; 12 specific cancer types also showed similar significant correlations [p < 0.05] as overall cancer MIR. The analysis of this study suggested that cancer MIR is greater in middle/low-income countries. Furthermore, the WHO healthcare score was associated with improved cancer outcomes in middle/low-income countries while absolute levels of financial resources and infrastructure played a more important role in high-income countries