Abstract
PURPOSE: For patients with muscle-invasive bladder cancer (MIBC), time to cystectomy and receipt of neoadjuvant chemotherapy are associated with improved survival. Travel burden may be an important barrier to timely guideline-concordant treatment. MATERIALS AND METHODS: We conducted a cross-sectional study of patients in Pennsylvania with a first lifetime cancer diagnosis of MIBC who underwent radical cystectomy at non-federal short-term general hospitals identified in 2010-2016 Pennsylvania Cancer Registry linked to Pennsylvania Healthcare Cost Containment Council (PHC4) inpatient data through 2018. Physician location came from the Centers for Medicare and Medicaid Services. RESULTS: Mean (standard deviation) drive time to nearest oncologist was 17.1 (11.4) minutes and to nearest urologist was 13.9 (9.2) minutes. A 30-minute increase in drive time to the urologist was associated with a 12.5 percentage point lower likelihood of undergoing cystectomy within 90 days (95% CI: -24.3 to -0.6), with greater effects for more socioeconomically disadvantaged areas (18.7 percentage point lower [95% CI: -33.1 to -4.3]). A 30-minute increase to the oncologist was associated with an 11.9 percentage point lower likelihood of receiving neoadjuvant chemotherapy (95% CI: -23.4 to -0.4). Drive time was not significantly associated with 90-day mortality or readmission. CONCLUSIONS: Drive time to oncologists and urologists is associated with timely receipt of guideline-recommended care for patients with MIBC. Understanding the impact of geographic access on clinical outcomes for patients with cancer who require multispecialty care can inform providers and policymakers in efforts to improve cancer care access and outcomes.