Route and efficiency analysis of cancer health care (REACH): Investigating sociodemographic and rurality of metastatic breast cancer patients at an NCI-designated facility

Purpose: Breast cancer is one of the most common malignancies affecting women worldwide. Metastatic breast cancer (MBC) patients experience unique challenges regarding access to care, particularly rural populations. Geographic location may increase travel, impacting time to treatment and adding to patient burden. This study aimed to evaluate the association between rurality and access to care by examining travel distance, time to treatment, and sociodemographic factors in patients with MBC. Methods: We conducted a retrospective cohort study using data from Siteman Cancer Center (SCC) Oncology Data Services registry from 2011–2021 with 519 female MBC patients. Rurality was defined by state definition. We used Geographic Information Systems (GIS) software to calculate travel distances and times from patients’ homes to treatment site. We evaluated travel distance (miles) and time to treatment initiation (days) using t-tests and ANOVA and evaluated any differences based on sociodemographic characteristics. Findings: We found that rural patients traveled farther for treatment compared to urban patients (mean 87.3 miles vs. 18.0 miles; p < 0.001). There was no statistically significant difference found with time to treatment initiation between groups (mean 36.1 vs. 35.0 days; p = 0.68). No difference in travel time or treatment initiation was found when comparing sociodemographic factors, including insurance status and comorbidity scores. Conclusions: Rural MBC patients face longer travel times, which may contribute to barriers to care. However, we found no difference for time to treatment initiation. Future studies characterizing rural patients' experiences can contribute to the development of targeted interventions to mitigate rural patient burden and improve access to cancer care.