Abstract

Superior survival outcomes are obtained by patients with ovarian cancer who are treated by experienced gynecologic oncologists and in hospitals with high case volumes. The relationship between ovarian cancer case volume and survival outcomes has led to recommendations for centralizing ovarian cancer care in high-volume institutions in the United States. With estimates that 25% to 35% of patients currently receive care in low-volume institutions, consolidating ovarian cancer care is challenging. Referring patients with ovarian cancer to high-volume centers is likely to require many patients to travel far from home for evaluation and treatment. Centralizing ovarian cancer may be a significant travel burden for many patients. The preferences of ovarian cancer patients regarding treatment location is unknown, as is whether they balance travel distance against survival outcomes. The aim of this cross-sectional survey was to determine how patients balance survival benefit against the burdens of travel to a distant referral center. The study was conducted between February 2015 and February 2016. Two discrete choice experiments (DCEs) assessed preferences of patients presenting for evaluation of adnexal masses. Discrete choice experiment 1 assessed the absolute increase (≤6%) in survival benefit that patients require to justify an additional 50 miles' travel distance to a referral center. Discrete choice experiment 2 assessed the distance participants would be willing to travel for a 6% improvement or greater in 5-year survival benefit. Patient demographic characteristics were collected together with measures of health numeracy, social support, and comfort with travel. t Tests were used to calculate significant differences between group means. A total of 64 women were enrolled at 1 of 2 gynecologic oncology clinics. For 81% (50/62) of patients in the DCE 1 group, a 5-year survival benefit of 6% or less was required to justify 50 miles of additional travel. Patients in this group 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) compared with those requiring greater than 6% benefit to travel 50 miles. For 80% (44/55) of patients in the DCE 2 group, a 5-year survival benefit of 6% or greater was required to justify 50 miles of additional travel. There was no association in the DCE 2 group between willingness to travel and collected sociodemographic covariates. These findings show that 1 in 5 patients with ovarian cancer would not travel 50 miles for survival benefits of high-volume care. Travel preferences of patients should be considered by policy makers when referral structures for care are designed. The study is limited by its small sample size and geographic bias in that the majority of participants live in urban areas and have ample access to gynecologic oncology care. 152 Obstetrical and Gynecological Survey Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.