Bridging the Gap: Examining the Association of Travel Burden With Treatment Administration and Survival in Stage II/III Gastric Cancer

PURPOSE Travel burden has been identified as a source of care disparities in other malignancies, but its impact on gastric cancer care is poorly understood. Therefore, we investigated the impact of travel burden on treatment administration for stage II/III patients and its association with survival. METHODS This was a retrospective cohort study among patients diagnosed with stage II/III gastric cancer from 2004 to 2021 in the National Cancer Database. Travel burden was measured as distance from treatment facility to patient's ZIP code (great circle distance [GCD]). We analyzed differences in treatment administration across GCD categories and the impact of GCD on overall survival (OS). RESULTS We identified 16,826 patients with stage II/III gastric cancer in the following GCD categories: 0-25 miles (n = 11,301 [67.2%]), 25-50 miles (n = 2,566 [15.3%]), 50-100 miles (n = 1,746 [10.4%]), and 100-300 miles (n = 1,213 [7.2%]). Patients in high GCD categories experienced increased rates of delays in care initiation (0-25 miles: 13.7%, 100-300 miles: 17.1%, P < .001), fragmented care (0-25 miles: 57.6%, 100-300 miles: 72.6%, P < .001), and delay between chemotherapy and surgery (0-25 miles: 23.0%, 100-300 miles: 27.3%, P < .001). Median OS decreased with increasing GCD categories (0-25 miles: 41.0 mo, 100-300 miles: 34.9 mo, P = .003) and persisted after adjusting for clinical, demographic, and socioeconomic variables (100-300 miles hazard ratio, 1.12 [1.03-1.21], P = .008). Care fragmentation was associated with reduced OS, even if patients received care at academic (fragmented: 39.9 mo [37.8-42.8], nonfragmented: 50.4 mo [45.7-54.6]), or high-volume centers (fragmented: 38.8 mo [36.9-41.2], nonfragmented: 47.4 mo [44.2-50.7]). CONCLUSION Increased travel burden was associated with delayed treatment administration and increased care fragmentation and was independently associated with increased mortality, particularly in patients traveling 100-300 miles. Understanding the impact of travel burden on gastric cancer care and outcomes can help guide future resource allocation for patients.