Abstract Introduction: Childhood cancer treatment typically occurs in specialized tertiary care centers in urban areas, resulting in a significant travel burden for children with cancer and their families. Mixed results have been observed of the effect of travel burden on pediatric cancer outcomes; however, many measures of travel burden are flawed. The objective of this study was to quantify the association between the travel distance from patients’ homes and their treatment centers and pediatric cancer mortality. Methods: We conducted a population-based longitudinal study using data from the Iowa Cancer Registry and Louisiana Tumor Registry. This study included all children with cancer diagnosed at age 0-19 from 2000 to 2020 in the two states. Multiple imputation with chained equations was used to handle missing data. Travel distance was reported as the distance between patients’ homes and their treatment facilities in miles using the great circle distance method in ArcGIS Pro. Neighborhood deprivation was measured with the Area Deprivation Index. Cox proportional hazards regression models were used to compute the association between distance to treatment and cancer-specific mortality. A directed acyclic graph was used to identify the variables needed to control for confounding in multivariable analyses. Results: The study included 4,871 children with cancer; 2,151 children were diagnosed in Iowa and 2,720 were diagnosed in Louisiana. Overall, the median travel distance was 32.54 miles and 17.70% of children lived over 100 miles from their treatment center. A greater proportion of children in Iowa lived over 100 miles from their treatment center compared to children in Louisiana (19.24% vs. 16.47%, p=0.01). Rurality as measured by Rural Urban Commuting Area codes was a poor proxy for high travel burden; 26.51% of children in rural census tracts were in the high travel burden group compared to 14.57% of children in urban census tracts. Travel burden increased with increasing levels of neighborhood deprivation (p0.0001) and was highest among American Indian/Alaskan Native children. Compared to children living less than 100 miles from their treatment center, those living 100+ miles away were 1.26 times more likely to die from their cancer (95% CI: 1.06-1.49). The association between travel burden and mortality differed by cancer type, with the greatest association among children with hematologic malignancies (aHR=1.70, 95% CI: 1.20-2.40). Conclusions: In our study, we demonstrated how cancer registry data can be used to quantify travel burden for children with cancer and their families. Travel burden was highest among racial/ethnic minorities and children living in areas of high neighborhood deprivation. Increased travel burden was associated with poor cancer survival in children. In additional analyses, we will explore differences in the effect of estimated travel time on survival rather than travel distance. Citation Format: Emma Hymel, Kendra L. Ratnapradipa, Cheng Zheng, Jenna Allison, Edward S. Peters, Sarah H. Nash, Mei-Chin Hsieh, Shinobu Watanabe-Galloway. Travel burden and pediatric cancer mortality: Evidence from 2000-2020 state cancer registry data abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A073.
Hymel et al. (Thu,) studied this question.
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