The influence of urban versus rural residence and travel distance on net income, out-of-pocket payments and quality of life in German head and neck cancer survivors.

PURPOSE: German HNC survivors frequently experience substantial financial burden (FB). Geographic distance to cancer care centers (CCC) may increase FB negatively affecting QoL and outcome by creating barriers to diagnosis, treatment, and aftercare. We evaluated the impact of distance to CCC on FB and provide insights into socioeconomic conditions of HNC patients.

METHODS

Between August 2022 and March 2023, 200 HNC patients completed a comprehensive questionnaire assessing financial aspects, including self-reported FB, and the EORTC QLQ-C30. Distances from each patient's residence to the treating CCC were recorded and analyzed in relation to socioeconomic characteristics. Parametric and non-parametric statistical methods were applied to assess subgroup differences associated with travel distance.

RESULTS

The mean travel distance was 27.9 km (95% CI 20.3-35.5). Patients residing in rural areas and farther from aftercare centers reported significantly higher out-of-pocket payments due to travel expenses and additional costs. A significant income disparity was observed between HNC patients living in urban cores and the general population within the same ZIP code (Δ - 499.56€; p = 0.014). Rural patients reported significantly higher financial difficulty scores on the EORTC QLQ-C30, reflecting greater FB and impaired QoL (p < 0.001). Overall, HNC survivors had significantly lower income than the general population, with the lowest levels observed among urban patients.

CONCLUSION

Increased distance to CCC is associated with higher FB and reduced QoL among HNC survivors, even in a statutory healthcare system. These disparities highlight the need for targeted interventions to reduce financial toxicity and improve access to cancer aftercare.