Hospital quality factors influencing the mobility of patients for radical prostate cancer radiotherapy: a national population based study

Publication date: Available online 24 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Ajay Aggarwal, Daniel Lewis, Arunan Sujenthiran, Susan C. Charman, Richard Sullivan, Heather Payne, Malcolm Mason, Jan van der Meulen
IntroductionPatient choice policies have been introduced across publicly funded health systems to give patients more control over their care, and to encourage quality improvement amongst providers. To date we have no empirical evidence that patients requiring radiation treatment are prepared to travel to alternative more distant centres or the factors that influence this.Materials and MethodsWe present the results of a national cohort study using administrative hospital data for all 44,363 men who were diagnosed with prostate cancer and underwent radical radiotherapy in the English National Health Service between 2010 and 2014. Using geographic information systems we investigated the extent to which men choose to travel beyond ("bypass") their nearest radiotherapy centre and conditional logistic regression to estimate the effect of hospital and patient characteristics on this mobility.Results20.7% (n= 9,161) of men bypassed their nearest radiotherapy centre. Travel time had a very strong impact on where patients moved to for their treatment, but its effect was smaller for men who were younger, more affluent, and from rural areas (p for interaction always <0·001). Men were prepared to travel further to hospitals that offered hypofractionated prostate radiotherapy as their standard schedule (odds ratio 3.19, p<0.001), to large-scale radiotherapy units (odds ratio 1.56 P<0.001) and to hospitals that were early adopters of intensity modulated radiotherapy (odds ratio 1.37, p<0.001).ConclusionMen with prostate cancer are prepared to bypass their nearest radiotherapy centres. They are more likely to travel to larger established centres and those that offer innovative technology and more convenient radiotherapy schedules. Indicators, which accurately reflect the quality of radiotherapy delivered are needed to guide patients' choices for radiotherapy treatment. In their absence, patient mobility may negatively affect the efficiency and capacity of a regional or national radiotherapy service and offer perverse incentives for technology adoption.

Teaser

Using geographic information systems and econometric modelling we present the first national study evaluating the hospital quality factors that attract patients for radiotherapy treatment in health-care markets. We found that one in five men bypassed their nearest radiotherapy centre for treatment, especially those who were younger, and more affluent. In the absence of indicators reflecting treatment quality, centres that were early adopters of intensity modulated radiotherapy or that offered shorter hypofractionated treatment schedules were more attractive to patients.


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