Survival Benefit Not Enough to Justify Centralized Ovarian Cancer Care

One in five patients with ovarian cancer said that they would not be willing to travel an additional 50 miles for cancer care for only a 6% 5-year survival benefit, according to the results of a study published in Gynecologic Oncology. However, the majority of surveyed women required a 5-year survival benefit of 6% or less to justify the additional travel.

“The women most likely to face this tradeoff are the 9% of the United States population living in counties > 50 miles distant from the closest gynecologic oncologist and the 15% of the United States population living in a Hospital Referral Region without a gynecologic oncologist,” wrote David I. Shalowitz, MD, of the department of obstetrics and gynecology at Wake Forest University in Winston-Salem, North Carolina, and colleagues. “These low-access regions of the United States should therefore be the first to benefit from interventions to 1) decrease the burdens of travel for women with ovarian cancer, 2) extend high-volume cancer care networks to underserved areas, including virtual and in-person outreach by gynecologic oncologists, and 3) improve the quality of the clinical care infrastructure at lower-volume cancer centers.”

Because patients with ovarian cancer have better clinical outcomes when treated at high-volume institutions, some have called for a centralization of ovarian cancer care at these centers. To determine how women would balance survival benefit against this additional travel to centralized treatment centers, Shalowitz and colleagues conducted a cross-sectional survey of women presenting to one of two clinics with a pelvic mass between February 2015 and 2016. Participants completed two discrete choice experiments, assessing the 5-year survival benefit required to justify 50 miles of additional travel, and the additional distance patients would travel for a 6% 5-year survival benefit.

The study included 62 participants, of whom 81% required a 5-year survival benefit of 6% or less to justify the additional 50 miles of travel. These participants were less likely to be employed (56% vs 83%; P = .05) and more likely to rate their health as good to excellent (86% vs 50%; P = .04) compared with those unwilling to travel this distance for the benefit.

Similarly, 80% of the participants said that they would travel 50 miles or more for a 6% survival benefit at 5 years. Almost half of the participants (47%) said that they would travel at least 250 miles for a 5-year survival benefit of 6%.

“We were unable to identify any significant demographic, geographic, or psychosocial differences between the groups of participants willing to travel an additional 50 miles for a 6% improvement in 5-year survival and those unwilling to travel, though at least one discrete choice experiment suggested that patients who are healthier, not currently employed, and less connected to their local neighborhood may be more willing to travel greater distances for care,” the researchers wrote. “Larger-scale study of cancer patients’ willingness to travel for care may reveal predictive characteristics not captured in this study; however, it is possible that willingness to travel is not reducible to other measurable factors.”