Travel Times Still a Challenge for Rural Health, Access Disparities

February 28, 2020 - Women with breast cancer living in rural areas can travel up to 2,000 miles over the course of their treatment, according to research out of the University of Minnesota School of Public Health, underscoring the care access disparities faced by individuals living in rural parts of the country.

Individuals with breast cancer typically undergo extensive radiation treatment up to five days each week, usually on an outpatient basis. As such, patients must drive or obtain transportation to and from treatment.

But that’s a lot easier said than done for patients living in a rural setting, where radiation facilities may be few and far between. Patients who live far away from these facilities face tremendous geographic barriers that make it challenging and cumbersome for them to actually access their care, the researchers found.

In an assessment of over 52,000 female patients diagnosed with breast cancer between 2004 and 2013, the researchers found that urban-dwelling patients had to travel less for their appointments.

The analysis, which used patient data to determine home address and Google Maps algorithms to determine distance traveled, the team determined that individuals in rural areas traveled three-times the distance urban-dwellers did for radiation treatment.

READ MORE: Strategies for Rural Patient Healthcare Access Challenges

Individuals in rural areas traveled an average of 40.8 miles to their radiation treatment, while those in urban areas traveled about 15.4 miles.

This trend occurred largely because treatment facilities were further away for those living in rural areas, the team added. The closest radiation facility was an average of 21.9 miles away from an individual living in a rural setting; for those in urban areas, that number was 4.8 miles.

And because of how often patients have to travel to their treatments, this can add up quickly, according to the study’s leader Colleen Longacre, a PhD student.

“Radiation treatment is not just a one-time thing,” Longacre said in a statement. “Conventional radiotherapy requires treatment five days per week for five-to-seven weeks at a time. This means that the average rural woman logs more than 2,000 miles of travel over the course of treatment.”

What’s more, the data revealed that a patient’s life circumstances influenced how far she needed to travel for care. Although Longacre and her team hypothesized that individuals with more severe forms of cancer would be willing to travel further to obtain certain levels of care, that was not the case.

Instead, the team found that women who were married, younger, or with higher incomes, were willing to travel further for more intensive treatment. Women who were older, widowed, single, and from low incomes were more likely to opt for radiation facilities that were closer to their homes.

“Basically, how far someone travels for treatment says more about the person than their cancer,” said Longacre.

Instead, it could depend on the resources the patient has, the data suggests. A patient who is married or with a higher income may be able to take more time from work or home to travel long distances for higher-quality care. Individuals with lower incomes or less support from loved ones at home may not be able to dedicate as much time to traveling to radiation treatments, although the researchers did not report on any statistics indicating such.

Medical professionals can use this information to augment how they treat patients with breast cancer, the researchers said. Providers may be mindful of referrals for patients living in rural areas, providing them with realistic care sites for treatment access. They may also refer patients to transportation assistance programs and other social services to help with the geographic divide.

Going forward, Longacre and team plan to look at the effects on care access and utilization that long travel distances cause.

Separate data has suggested that these longer travel times can impede access for individuals living in rural areas. A 2018 report from Pew Research Center revealed that patients living in rural areas face a 17-minute trek to the nearest hospital, while those living in urban areas only face 10-minute travel times.

That equates to 4.4 miles in travel distance for those in urban areas, 5.6 miles in suburban areas, and 10.5 miles to the nearest hospital in rural settings.

And this has impacts on care access, another Pew study found. Nearly one-quarter of those living in rural areas say getting access to quality healthcare that is close to home is a challenge. This comes as individuals living in rural regions also face a number of other social determinants of health and chronic illness.

Organizations are working to address this issue largely by leaning on telehealth. At the University of California Davis, telehealth reduced distance traveled by 5 million miles for all patients between 1996 and 2013, the researchers reported. This amounted to nearly nine years’ worth of saved travel time and $3 million in saved travel costs.

But telehealth is no good for the women included in Longacre’s study who have breast cancer. A patient needs to visit the doctor to receive this medication, putting the travel distance question front and center.

This issue is likely not going away, as rural areas continue to see more hospital closures. But with the topic of rural health emerging as a priority for population health experts, more data will be necessary to address health disparities.