Aims: In Australia, treatment of oral cavity cancer is largely centralised in metropolitan specialist centres, requiring people living in rural areas to travel longer and further for care. We examined the impact of travel time and distance on treatment patterns and clinical outcomes for oral cavity cancer in NSW and ACT.
Methods: De-identified linked administrative health data from multiple sources were obtained from the Centre for Health Record Linkage for people diagnosed with oral cavity cancer (ICD-O-3 codes C02-C06) in NSW and ACT between 2005 and 2019, with mortality follow-up to 31 December 2019. Travel burden was examined using quintiles of estimated travel time and distance (Q1 lowest, Q5 highest) from the Statistical Area Level 2 (SA2) of residence to the nearest multidisciplinary head and neck cancer service. Outcomes included stage at diagnosis, receipt of surgery, time from diagnosis to surgery, 30-day, 90-day, and 12-month mortality, and 5-year overall survival.
Results: Among 2,457 people with oral cavity cancer, 1,839 (74.9%) underwent surgery. Travel-time quintile was not associated with stage at diagnosis. Compared with those in the lowest travel-time quintile, patients in the highest quintile had greater odds of not receiving surgery (adjusted OR 1.88; 95% CI 1.35, 2.63) and of receiving surgery more than 28 days after diagnosis (adjusted OR 1.53; 95% CI 1.06, 2.21). Among people who underwent surgery, travel-time quintile showed no clear association with 30-day, 90-day, or 12-month mortality or with 5-year overall survival. Similar findings were observed for distance quintiles.
Conclusions: Greater travel burden to multidisciplinary head and neck cancer services was associated with reduced uptake of surgery and longer time to surgical treatment. These findings highlight the need to improve equitable access to specialist surgical care for patients living further from multidisciplinary treatment centres.