Association of travel burden (TB) with colorectal cancer (CRC) outcomes in resource-limited settings (RLS)

BackgroundThe impact of TB (which contributes to both financial and time toxicities) on cancer treatment and outcomes, especially in RLS remains largely understudied. We assessed the impact of TB on the outcomes of patients with CRC treated at a regional cancer center in RLS.MethodsAll patients with newly diagnosed CRC in 2022 at the State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, North India were enrolled. TB was recorded as the average time required to traverse the shortest distance between the cancer center and the place of the patient’s residence.Results263 patients (42.6% females) with CRC were included, including patients who travelled from their homes (group A) and those who rented apartments near the hospital to complete treatment (group B). Group A patients (N=178) travelled 22 km (48 mins) [median] to reach the cancer center while Group B patients (N=85) resided 75 km (130 mins) [median] away from the hospital. Travel time did not correlate with symptom duration prior to diagnosis of CRC. In group A, patients with highest TB (Q4 travel time) had poorer outcomes than other patients (Q1-Q3 of travel time) (18-month OS of 65% v 83.6%, adjusted HR 2.5 [95% CI 1.2 to 5.2]) (Table). 18-month OS in group B was higher than that for group A patients (85.6% v 78.9%, p=0.056). Table: 1584P Predictors of OS in patients with CRC [data expressed as HR (95% CI), p-value] Parameter Group A Group B Univariate analysis Multivariate analysis Univariate analysis Multivariate analysis 1. Age ≥50 years 1.6 (0.8 to 3.5), 0.2 1.3 (0.3 to 6.4), 0.8 2. Female sex 0.8 (0.4 to 1.5), 0.4 0.5 (0.1 to 2.3), 0.3 3. Presence of comorbidity 1.1 (0.5 to 2.1), 0.8 0.0 (0.0 to 8.0), 0.2 4. ECOG >1 3.6 (1.7 to 7.5), 0.001 3.4 (1.4 to 7.9), 0.005 0.8 (0.1 to 6.7), 0.9 5. Left vs right colon 1.3 (0.5 to 3.5), 0.6 1.6 (0.12 to 13.4), 0.7 6. Metastatic disease 8.1 (4.0 to 16.2), <0.0001 4.9 (2.3 to 10.6), <0.0001 10.5 (2.4 to 45.5), 0.002 8.4 (1.7 to 42.3), 0.01 7. Grade 3 tumor 8.2 (4.1 to 16.6), <0.0001 5.7 (2.7 to 12.2), <0.0001 0.0 (0.0 to >100), 0.6 8. Travel time top quartile 2.3 (1.2 to 4.6), 0.02 2.5 (1.2 to 5.2), 0.02 ConclusionsOur study demonstrates that TB is significantly associated with poorer outcomes in patients with CRC.Legal entity responsible for the studyS.Z. Banday.FundingHas not received any funding.DisclosureB. Gyawali: Financial Interests, Personal, Writing Engagement, For writing Medscape Columns: Medscape; Financial Interests, Personal, Invited Speaker, For giving invited talks and grand rounds at universities, cancer centers and professional societies: Various academic and professional organizations; Financial Interests, Personal, Other, Consulting services: Vivio Health; Non-Financial Interests, Member: ASCO, IASLC, JSMO. All other authors have declared no conflicts of interest.