On the Association between Travel Distance and Treatment Choice for Low-Risk Prostate Cancer: Results from a Rural State

Abstract

Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment facility and initial treatment choice among young men with low-risk prostate cancer in a rural state. Methods: A retros-pective medical charts review was conducted of young men (65 years or younger) newly diagnosed with low-risk prostate cancer from January 1, 2005 through De-cember 31, 2014 who were treated with either active surveillance, radical prosta-tectomy, or brachytherapy at either of the two major hospital systems in Bismarck, ND, USA. Results: Information on a random sample of 242 patients was studied. The majority of patients (66%) received radical prostatectomy. Patients who received radical prostatectomy were significantly younger (p-value < 0.001). PSA at diagnosis, clinical stage, and Gleason score were not associated with treatment choice (p-value = 0.06; p-value = 0.1794; and p-value = 1.00; respectively). Adjusting for age at diag-nosis, PSA at diagnosis, and treatment facility, treatment choice was not associated with travel distance (p-value = 0.309). Patients treated at St. Alexius facility were more likely to undergo radical prostatectomy than Sanford health patients (p-value < 0.0001). Conclusions: We found no association between travel distance and treat-ment choice for low-risk prostate cancer. Treatment choice was associated with in-stitution which may suggest institutional bias in patterns of care.