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Are patients willing to travel for better ovarian cancer care?

Shalowitz DI, Nivasch E, Burger RA, Schapira MM. Are patients willing to travel for better ovarian cancer care? Gynecologic oncology. 2018 Jan 1; 148(1):42-48.

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OBJECTIVE: Improved outcomes realized by patients treated at high-volume institutions have led to a call for centralization of ovarian cancer care. However, it is unknown whether centralization respects patients' preferences regarding treatment location. This study's objective was to determine how patients balance survival benefit against the burdens of travel to a distant treatment center. METHODS: Patients presenting for evaluation of adnexal masses completed two discrete choice experiments (DCEs) assessing 1) the 5-year survival benefit required to justify 50miles of additional travel, and 2) the additional distance patients would travel for a 6% 5-year survival benefit. Demographic data were collected with measures of health numeracy, social support, and comfort with travel. t-Tests were performed to test for significant differences between group means. RESULTS: 81% (50/62) of participants required a 5-year survival benefit of 6% to justify 50miles of additional travel (DCE#1). These participants were less likely to be employed (56% vs 83%, p = 0.05) and more likely to rate their health as good to excellent (86% vs 50%, p = 0.04) than those requiring > 6% benefit to travel 50miles. 80% (44/55) of participants would travel 50miles for a set 5-year survival benefit of 6% (DCE#2). No association was identified in DCE#2 between willingness to travel and collected sociodemographic covariates. CONCLUSIONS: 1 in 5 patients with ovarian cancer may prefer not to travel to a referral center, even when aware of the survival benefits of doing so. Policymakers should consider patients' travel preferences in designing referral structures for care.

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