The closing of rural hospitals and specialty care units is causing many people, including breast cancer patients, to seek treatment far from home. A study from the School of Public Health recently found that U.S. rural breast cancer patients typically travel three times as far as urban women for radiation therapy to treat their disease.

The study was led by PhD student Colleen Longacre and appeared in The Journal of Rural Health.

Longacre looked at Medicare data from more than 52,000 women diagnosed with breast cancer between 2004 and 2013. The data was used to determine where the women lived and the location of the facility where they received radiation therapy. Google Maps was used to calculate the distance the women traveled for their treatment. 

The study found:

• patients living in rural areas traveled, on average, nearly three times as far as woman living in urban areas for radiation treatment: 40.8 miles vs. 15.4 miles;
• the nearest radiation facility for rural women was, on average, four times farther away than for urban women: 21.9 miles vs. 4.8 miles;

“Radiation treatment is not just a one-time thing,” says Longacre. “Conventional radiotherapy requires treatment five days per week for five-to-seven weeks at a time. This means that the average rural woman logs more than 2,000 miles of travel over the course of treatment.”

Longacre also wanted to detail some of the basic characteristics of women who traveled longer distances, either by choice or necessity.

“We hypothesized that women with more severe or complex disease may elect to travel farther to larger, more specialized treatment centers,” says Longacre. “Overall, we didn’t see that at all.”

Instead, the study revealed:

• the severity of the cancer case was not associated with how far women chose to travel for care;
• people who chose to travel to a clinic farther away than the nearest facility were typically younger, married or from higher income areas;
• women who were older, single or widowed, and from lower income areas chose to travel shorter distances for treatment.

“Basically, how far someone travels for treatment says more about the person than their cancer,” said Longacre. 

For solutions, Longacre suggests providers begin by understanding and taking into account the travel burden faced by their patients — especially those in rural areas — and take this into account when making treatment recommendations. She also recommends making patients more aware of social support services that can help them with travel and lodging.

Longacre is continuing her research by studying the barriers to care due to distance and how they may prompt some women to forgo cancer treatment altogether.