Cancer Epidemiol. 2026 Apr 7;102:103070. doi: 10.1016/j.canep.2026.103070. Online ahead of print.
ABSTRACT
BACKGROUND: Most children with cancer receive care at specialized tertiary centers in urban areas, creating substantial travel demands for many patients and their families. Prior studies on the relationship between travel burden and pediatric cancer survival have yielded inconsistent findings, in part due to limitations in how travel burden is measured.
METHODS: This population-based cohort study analyzed data from the Iowa Cancer Registry and the Louisiana Tumor Registry, including all cancer cases diagnosed at ages 0-19 from 2000 to 2020. Travel distance was estimated with ArcGIS Pro using the great-circle distance (miles) between patients’ residences and treatment facilities. For cases diagnosed in Iowa, travel time (minutes) was estimated using the Origin-Destination Cost Matrix tool. We applied Cox proportional hazards models to examine associations between travel burden and mortality, with confounders selected using a directed acyclic graph approach.
RESULTS: A total of 4871 patients were included (2151 in Iowa; 2720 in Louisiana). Overall, the median travel distance was 32.54 miles (IQR: 8.46-76.47). Travel distance was higher for children residing in rural census tracts and more deprived neighborhoods. The hazard of cancer death among those with a high travel distance (Q4) was 1.41 times higher (95% CI: 1.20-1.65) than those with a low travel distance (Q1-Q3). For the Iowa subset, travel distance was a good approximation of travel time.
CONCLUSIONS: Children experiencing high travel distance have poorer survival than those with lower travel burden. These findings underscore the need for interventions and policies to reduce treatment-related travel burden in pediatric cancer care.
PMID:41950538 | DOI:10.1016/j.canep.2026.103070
