Motorized travel time to access childhood cancer care in India: A multi-center geospatial analysis.
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BACKGROUND: Delays in diagnosis and treatment, driven in part by limited geographic access to specialized care, continue to hinder childhood cancer outcomes. In this study, we aimed to evaluate motorized travel times for children seeking care at three referral childhood cancer centers in India. METHODS: This multi-center retrospective study analyzed individual-patient level data for children (aged ≤19 years) diagnosed with cancer between 2005 and 2019 at three tertiary hospitals in India: All India Institute of Medical Sciences (AIIMS) and Rajiv Gandhi Cancer Institute (RGCI) in New Delhi, and Women's Indian Association (WIA) Cancer Institute in Chennai. Patient residential addresses were geocoded, and travel times were estimated using Malaria Atlas Project friction surface rasters and Dijkstra's algorithm. An exploratory logistic regression analysis was performed to identify factors associated with prolonged motorized travel time (>60 min). RESULTS: A total of 22,328 patients with a median age of 10 years (IQR 4-15), 32·5% (n = 7261) female, and 54·2% (n = 12,093) with solid malignancies were included. The median motorized travel time was 161 min (IQR 27-430), with 73·5% of patients traveling > 60 min. Male sex (aOR 1·23, 95% CI: 1·15-1·31; p < 0·001) and solid malignancies (aOR 1·09, 95% CI: 1·03-1·16; p = 0·004) were associated with prolonged travel time. Compared with AIIMS, WIA had higher odds (aOR 2·79, 95% CI: 2·58-3·03) and RGCI had lower odds (aOR 0·69, 95% CI: 0·65-0·74) of prolonged travel time (p < 0·001). CONCLUSION: Children with cancer in India face a substantial travel time burden to access cancer care, highlighting the need for expansion of pediatric oncology services. POLICY SUMMARY: There is a need for policies that expand pediatric oncology capacity beyond major urban referral centers, strengthen regional treatment networks, and improve referral systems to reduce delays and disparities in diagnosis and treatment and improve childhood cancer outcomes.