Are Patients Willing to Travel for Cancer Surgery?

November 27, 2018

Survey results published in JAMA Network Open looked at motivating factors behind patient travel and how far they were willing to go for treatment.

An online survey found more than nine in 10 patients were willing to travel to a safer hospital to undergo complex cancer surgery, with about one-third of these patients motivated to travel by less than a 1% safety or quality advantage. However, the majority of these patients reported barriers to travel, according to a study published in JAMA Network Open.

“This finding is in line with two previous surveys which demonstrated that approximately 50% of patients in the United States were willing to travel longer than 5 hours for a reduction in mortality and that, of 214 patients presenting for cancer surgery at a university hospital, nearly half had traveled more than 2 hours to see an experienced surgeon,” wrote researchers led by Benjamin J. Resio, MD, of Yale School of Medicine.

The nationally representative survey had a response rate of 55.9% with 1,016 respondents. Participants were asked to consider complex cancer surgery at their local hospital or a hospital that specialized in cancer 1 hour farther away. The median age of respondents was 48 with a median annual income between $60,000 and $75,000. The majority of respondents (85%) lived in a metropolitan area.

The median time to their local hospital was 15 minutes. The median time that respondents reported they were willing to travel to get to the best hospital for cancer surgery was 2 hours. There was no correlation between travel time to a local hospital and travel time respondents would accept to attend the best hospital for surgery.

Of the possible motivators for traveling to a specialty hospital, 92% of respondents were motivated by the chance of superior outcomes. Between 30% and 38% of respondents reported a willingness to travel for only a minimal differential favoring the specialty hospital.

Among the respondents most resistant to moving to a specialty hospital were those with a lower income (odds ratio [OR], 2.01), nonwhite race (OR, 1.60), metropolitan residence (OR, 2.08), personal history of cancer (OR, 2.07), and not having received surgery in the past (OR, 1.40).

Three-quarters of the respondents noted at least one barrier to traveling 1 hour to a specialty hospital. Financial barriers were the most common, including a belief that insurance coverage would restrict them from undergoing surgery at a specialty hospital (53%) or that surgery would be more expensive at a specialty hospital (37%).

Commenting on the results of the study, Jason Liu, MD, of the University of Chicago Hospitals, and American College of Surgeons Clinical Scholar in Residence, called the study interesting and important.

“It shows just how significant of a health policy decision it is to regionalize care in the United States,” Liu told Cancer Network. “There are so many considerations to what on the surface seems like a simple decision.”

“The first study on this topic conducted by Dr. Sam Finlayson showed that no one was willing to travel. Now it seems people are willing to travel to a certain extent,” Liu said. “What might be more important is how [we can] provide patients with trustworthy data in easily digestible formats so that they can make an informed decision about where they choose to get their care. Even more important, how can we ensure that hospitals and surgeons across the United States that offer cancer surgery have the optimal resources to care for these patients and that they follow the best available medical evidence? High-quality cancer surgery care can be provided without regionalization if we verify that hospitals and surgeons offering these operations have the resources and the know how to do so safely,” said Liu.