Travel-time barriers to specialized cancer care for adolescents and young adults with acute lymphoblastic leukemia.

BACKGROUND: Prior studies demonstrate that 20%-50% of adolescents and young adults (age 15-39 years) with acute lymphoblastic leukemia (ALL) receive care at specialty cancer centers, yet a survival benefit has been observed for patients at these sites. Our objective was to identify patients at risk of severe geographic barriers to specialty cancer center-level care. METHODS: We used data from the North American Association of Central Cancer Registries Cancer in North America database to identify adolescent and young adult ALL patients diagnosed between 2004 and 2016 across 43 US states. We calculated driving distance and travel time from counties where participants lived to the closest specialty cancer center sites. We then used multivariable logistic regression models to examine the relationship between sociodemographic characteristics of counties where adolescent and young adult ALL patients resided and the need to travel more than 1 hour to obtain care at a specialty cancer center. RESULTS: Among 11 813 adolescent and young adult ALL patients, 43.4% were aged 25-39 years, 65.5% were male, 32.9% were Hispanic, and 28.7% had public insurance. We found 23.6% of adolescent and young adult ALL patients from 60.8% of included US counties would be required to travel more than 1 hour one way to access a specialty cancer center. Multivariable models demonstrate that patients living in counties that are nonmetropolitan, with lower levels of educational attainment, with higher income inequality, with lower internet access, located in primary care physician shortage areas, and with fewer hospitals providing chemotherapy services are more likely to travel more than 1 hour to access a specialty cancer center. CONCLUSIONS: Substantial travel-related barriers exist to accessing care at specialty cancer centers across the United States, particularly for patients living in areas with greater concentrations of historically marginalized communities.

Advanced level nursing in England: organisational challenges and opportunities.

AIM: To explore the background, activities and future development needs of advanced practice nurses within a large NHS Trust in England, allowing for a wider review of the current situation within the UK. BACKGROUND: There are currently no national requirements for advanced practice nursing within the UK, which has led to considerable variability in these roles. Recently, focus has been placed on local governance rather than regulation of advanced practice nursing. However, governance and coordinated workforce planning within the UK is in its infancy. METHODS: An electronic survey was sent to all nurses within one Trust identified as practising at an advanced level; a total of 136 responses were received. RESULTS: The survey identified considerable variation in titles, educational preparation and current activities even within similar roles. Some participants identified the need for more support in undertaking professional development activities. CONCLUSIONS: The findings echo the wider picture within the UK, and point to the need to actively work on developing strategies for governance, education, and succession planning for advanced practice nursing. IMPLICATIONS FOR NURSING MANAGEMENT: In the absence of national regulation, UK NHS Trusts should develop their own registers of advanced practice nurses in order to facilitate improved management, governance and workforce planning systems.