Background: A consistent and unexpected association between distance to a treatment center and overall survival in patients with head and neck cancer has been reported in the literature. The greater the distance traveled, the greater the rate of survival. However, it remains to be seen whether there also exists an association between distance to treatment center and quality of life (QOL), a clinically significant patient-centered variable. This study investigates the role of distance to the treating facility as it relates to QOL in patients with head and neck cancer.
Methods: This was a retrospective observational study of 95 patients with head and neck squamous cell carcinoma (HNSCC) who underwent treatment at the Milton S. Hershey Medical Center and completed University of Washington Quality of Life (UWQOL) and Short Form 20 (SF-20) questionnaires between the years 2017-2021. The primary outcome of QOL was quantified utilizing the UWQOL and SF-20 surveys. Patient responses were categorized into the domains social/emotional and physical (UWQOL), and physical health, role functioning, social functioning, pain, mental health, and health perceptions (SF-20) for analysis. Distance was calculated using patient home addresses.
Results: Among 95 patients with HNSCC, there was a significant negative association between miles from the treatment site and the UWQOL social/emotional subscale (beta = -0.16, p = 0.035) and the SF-20 mental health subscale (beta = -0.15, p = 0.041), adjusted for survey responses over time. However, these associations were no longer significant with additional adjustment for race, gender, marital status, and insurance type (beta = -0.12, p = 0.09, and beta = -0.10, p = 0.18, respectively). Analysis of other variables, independent of distance to care, indicated that marital status was a significant predictor of UWQOL social/emotional score, driven by the comparison between remaining married versus those who were divorced/widowed (73.2 vs. 59.4, respectively, p < 0.001). The same was true for SF-20 physical health (61.9 vs. 41.3, p = 0.010), role functioning (68.2 vs. 31.8, p < 0.001), social functioning (85.2 vs. 65, p = 0.004), pain (35.3 vs. 54.1, p = 0.001), mental health (78.6 vs. 65.4, p = 0.002), and health perceptions (47.8 vs. 35.4, p = 0.018) subscales. White race was significantly associated with higher average UWQOL social/emotional score (78.0 vs. 54.1, p = 0.001), lower average SF-20 pain (33.9 vs. 55.2, p = 0.026) and higher average health perceptions score (50.3 vs. 29.1, p = 0.014) compared to non-whites.
Conclusion: The relationship between distance traveled to the treatment center and QOL did not correspond with the positive association between distance and overall survival reported in prior studies. QOL seems to be unchanged in some domains, and may actually be worse in others in patients who travel farther for care. Marital status and race were much stronger determinants of QOL than distance to the treatment center. This emphasizes the importance of a strong support structure for patients throughout their cancer treatment.