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Travel Distance as a Barrier to Receipt of Adjuvant Radiation Therapy After Radical Prostatectomy

Yang, David D., BA*; Muralidhar, Vinayak, MD, MSc; Mahal, Brandon A., MD; Beard, Clair J., MD*,‡; Mouw, Kent W., MD, PhD*,‡; Martin, Neil E., MD, MPH*,‡; Orio, Peter F. III, DO, MS*,‡; King, Martin T., MD, PhD*,‡; Nguyen, Paul L., MD*,‡

American Journal of Clinical Oncology: October 2018 - Volume 41 - Issue 10 - p 953–959
doi: 10.1097/COC.0000000000000410
Original Articles: Genitourinary

Objectives: Following radical prostatectomy (RP), adjuvant radiation therapy (RT) decreases biochemical recurrence and potentially improves metastasis-free and overall survival for patients with high-risk pathologic features. Since adjuvant RT typically occurs daily over several weeks, the logistical challenges of extensive traveling may be a significant barrier to its use. We examined the association between distance to treatment facility and use of adjuvant RT.

Materials and Methods: We identified 97,568 patients in the National Cancer Database diagnosed from 2004 through 2011 with cT1-4N0-xM0-x prostate cancer and found to have high-risk pathologic features (pT3-4 stage and/or positive surgical margins) at RP. Multivariable logistic regression adjusting for sociodemographic and clinicopathologic factors was used to examine the association between travel distance and receipt of adjuvant RT, defined as radiotherapy initiated within 12 months after RP.

Results: Overall, 10.6% (10,346) of the study cohort received adjuvant RT. On multivariable analysis, increasing travel distance was significantly associated with decreased use of adjuvant RT, with adjusted odds ratios of 1.0 (reference), 0.67, 0.46, 0.39, and 0.32 (all P<0.001) and prevalence of use at 12.6%, 8.8%, 6.3%, 4.9%, and 3.7% for patients living ≤25.0, 25.1 to 50.0, 50.1 to 75.0, 75.1 to 100.0, and >100.0 miles away, respectively.

Conclusions: Increasing travel distance was strongly associated with decreased use of adjuvant RT in this national cohort of postprostatectomy patients with high-risk pathologic features. These results strongly suggest that the logistical challenges of extensive travel are a significant barrier to the use of adjuvant RT. Efforts aimed at improving access to radiotherapy and reducing treatment time are urgently needed.

*Harvard Medical School

Harvard Radiation Oncology Program

Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA

Supported by the Prostate Cancer Foundation, Wood Family Foundation, the Baker Family, the Freeman Family, Fitz’s Cancer Warriors, David and Cynthia Chapin, the Frashure Family, Hugh Simons in honor of Frank and Anne Simons, the Campbell Family in honor of Joan Campbell, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous family foundation.

N.E.M. has received financial compensation for being a committee chair of Via Oncology. P.L.N. has consulted for Ferring Pharmaceuticals, Medivation, GenomeDx Biosciences, Dendreon, and Nanobiotix and received research support for clinical trials from Astellas Pharma and Janssen Pharmaceuticals. The remaining authors declare no conflicts of interest.

Reprints: Paul L. Nguyen, MD, Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, 75 Francis St, Boston, MA 02115. E-mail: pnguyen@lroc.harvard.edu.

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