Sierra M. Silverwood BA , Kathleen Waeldner BA , Sasha K. Demeulenaere BS , Shavit Keren BA , Jason To BS , Jie Jane Chen MD , Zakaria El Kouzi MD , Alan Ayoub MD , Surbhi Grover MD , Katie E. Lichter MD, MPH , Osama Mohamad MD, PhD
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Studies were included if they were primary literature, published between May 2000 and May 2023, and reported the travel distances for patients undergoing radiation therapy for malignant conditions and its influence on survival outcomes. Studies were excluded if they did not report primary outcomes, were published before 2000, or were non-English.</div></div><div><h3>Results</h3><div>After review, 23 studies were included. Most studies were conducted in the United States, with cervical cancer being the most frequently studied disease site. Data suggested that travel distances vary significantly, with patients often traveling a median distance of 20 miles to radiation therapy. Among the studies, 5 reported a negative impact on overall survival, often associating greater travel with nonadherence to recommended care. Other survival metrics, including progression-free survival and all-cause mortality, were also assessed, demonstrating similar variability in relation to travel distance. Conversely, seven studies found no significant impact on overall survival, and four suggested a positive impact on overall survival, with improved outcomes at centers with higher case volumes. Some data also revealed an inverse correlation between travel distance and the likelihood of receiving guideline-concordant radiation therapy.</div></div><div><h3>Conclusions</h3><div>The impact of travel distance on radiation therapy outcomes is varied. Our findings underscore the challenges posed by travel in accessing radiation therapy and the disparities affecting particular patient demographic groups. 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引用次数: 0
摘要
目的虽然放射治疗的最新技术进步显著改善了治疗效果，但放射治疗在全球的分布并不均衡，农村或资源匮乏地区的患者因旅行负担而难以获得放射治疗。本系统综述旨在探讨治疗设施的地理距离对接受放射治疗的患者的生存率及其他治疗效果的影响。方法与材料对四个数据库（PubMed、Embase、CINAHL 和 Web of Science）进行了检索。纳入的研究必须是 2000 年 5 月至 2023 年 5 月间发表的主要文献，并且报告了接受放射治疗的恶性肿瘤患者的旅行距离及其对生存结果的影响。未报告主要结果、发表于 2000 年之前或非英语的研究被排除在外。大多数研究在美国进行，宫颈癌是研究最多的疾病部位。数据显示，旅行距离差异很大，患者接受放射治疗的中位距离通常为 20 英里。在这些研究中，有 5 项研究报告了旅行对总生存率的负面影响，这些研究通常将更多的旅行与不坚持建议的治疗联系在一起。研究还评估了其他生存指标，包括无进展生存期和全因死亡率，结果表明旅行距离也会产生类似的变化。相反，有七项研究发现旅行距离对总生存率没有明显影响，有四项研究表明旅行距离对总生存率有积极影响，病例量较多的中心治疗效果更好。一些数据还显示，旅行距离与接受符合指南的放射治疗的可能性之间存在反相关关系。我们的研究结果强调了旅行对接受放射治疗带来的挑战，以及影响特定患者群体的差异。还需要进行更多的研究，以全面评估地域差异的影响，并确定应对这些挑战的有效措施。
The Relationship Between Travel Distance for Treatment and Outcomes in Patients Undergoing Radiation Therapy: A Systematic Review
Purpose
Although recent technological advances in radiation therapy have significantly improved treatment outcomes, the global distribution of radiation therapy is unbalanced, making access especially challenging for patients in rural or low-resource settings because of travel burden. This systematic review aimed to explore the impact of geographic distance to treatment facilities on survival, as well as other treatment outcomes, among patients undergoing radiation therapy.
Methods and Materials
A search of four databases (PubMed, Embase, CINAHL, and Web of Science) was performed. Studies were included if they were primary literature, published between May 2000 and May 2023, and reported the travel distances for patients undergoing radiation therapy for malignant conditions and its influence on survival outcomes. Studies were excluded if they did not report primary outcomes, were published before 2000, or were non-English.
Results
After review, 23 studies were included. Most studies were conducted in the United States, with cervical cancer being the most frequently studied disease site. Data suggested that travel distances vary significantly, with patients often traveling a median distance of 20 miles to radiation therapy. Among the studies, 5 reported a negative impact on overall survival, often associating greater travel with nonadherence to recommended care. Other survival metrics, including progression-free survival and all-cause mortality, were also assessed, demonstrating similar variability in relation to travel distance. Conversely, seven studies found no significant impact on overall survival, and four suggested a positive impact on overall survival, with improved outcomes at centers with higher case volumes. Some data also revealed an inverse correlation between travel distance and the likelihood of receiving guideline-concordant radiation therapy.
Conclusions
The impact of travel distance on radiation therapy outcomes is varied. Our findings underscore the challenges posed by travel in accessing radiation therapy and the disparities affecting particular patient demographic groups. Additional studies are needed to thoroughly assess the impacts of geographic disparities and to identify effective measures to address these challenges.
期刊介绍：
The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.
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