Evaluation of travel time to colorectal cancer care and survival: a cohort study using cancer registry data in Osaka Prefecture, Japan.

Abstract

Background: Cancer care in Japan faces a major challenge in maintaining equity in access and efficiency. Care is provided on the basis of catchment area, referred to as a secondary medical area (SMA); at least one designated cancer care hospital (DCCH) is placed in every SMA. We aimed to evaluate travel time and net survival by SMA among patients diagnosed with colorectal cancer (CRC) in Osaka Prefecture, Japan.

Methods: We used cancer registry data for this cohort study and included patients diagnosed with CRC during 2013-2018. We evaluated equality in the utilisation of care by travel time between patients' addresses and medical institutions for diagnosis or treatment in Osaka Prefecture. Travel time was compared by SMA of residence. We analysed which factors were associated with travel time using quantile regression. Efficiency was evaluated as un-standardised, age-standardised and stage-stratified three-year net survival by SMA of hospital for patients who received surgical resection.

Results: Among the 53,301 patients, the estimated median travel time was 27 (interquartile range14 to 61, 90^th percentile 82) minutes. Travel time varied between SMAs of residence by 20minutes and types of hospital (prefectural DCCH versus non-DCCH) by 15minutes at most. Regarding net survival, all SMA of hospital were within the 99.8% control limits. However, around 40% of hospitals had annual surgical volume below ten.

Conclusions: Travel time varied by SMA by 20minutes at most. Although net survival was equalised across catchment areas, the current situation suggests an over-regionalisation of surgical care. The entire prefecture may need to reallocate resources to achieve higher efficiency.

Policy summary: Reconfiguring cancer care might be inevitable to cut the waste of resource inputs, but access equity should also be considered when centralising care. (284 words).