Travel burden associated with rare cancers: The example of Merkel cell carcinoma

Abstract

Objective: The objective of this study was to understand the travel burden of MCC patients.

Methods: This study used data from an MCC registry at the Seattle Cancer Care Alliance (SCCA). All MCC patients enrolled at SCCA with a valid 3‐digit ZIP code were included. Patients were followed up from January 1, 2012 until their last fol-low‐up, death, or end of data (January 1, 2017). Travel burden was measured by one‐way travel distance to SCCA from each patient’s 3‐digit ZIP code. Patient demo-graphics, tumor characteristics, and follow‐up visit were evaluated and stratified by one‐way driving distance of ≤300 and >300 miles.

Results: A total of 391 MCC patients were included (68% men, mean age = 67 years [±SD = ±11 years], 67% residing in the West, and 70% white). At diagnosis, 53% of the patients had Stage III or IV MCC. Mean one‐way distance traveled by patients was 1,137 (median: 813) miles, and 57% of patients traveled >300 miles. Compared to patients who traveled ≤300 miles, those who traveled >300 miles were more likely to be <70 years old (46% vs 65%; P< 0.001), were diagnosed with advanced stage (III or IV) MCC (46% vs 59%; P= 0.01), had shorter follow‐up in the cancer registry (mean: 509 vs 212 days; P< 0.001), and had fewer visits during follow‐up (mean: 5.2 vs 2.5; P < 0.001). Conclusions: In this single cancer center study, the majority of MCC patients traveled long distances to receive expert care. Longer travel distances appeared to be associated with younger age, a more advanced stage of cancer at study entry and fewer in‐clinic visits, suggesting that travel burden may impact timely and adequate patient care for this rare cancer.