ArticleEcancermedicalscience2026
Association of travel burden with colorectal cancer outcomes in resource-limited settings of Kashmir, India.
Article in Ecancermedicalscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The impact of travel burden, which contributes to both financial and time toxicities, on cancer treatment and outcomes remains largely understudied, especially in resource-limited settings. We assessed the impact of travel burden on the outcomes of patients with colorectal cancer (CRC) treated at a regional cancer center in the resource-limited context of Kashmir, India. Methods: This was a retrospective study including all patients with newly diagnosed CRC in 2022 at the State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, North India. Travel burden was recorded as the average time required to traverse the shortest distance between the cancer center and the place of the patient's residence. We estimated the travel burden, analyzed the association of travel burden with survival outcomes, and compared outcomes for patients who traveled from their homes for treatment (Group A) to those who rented apartments near the hospital to complete treatment (Group B). Results: 263 patients (42.6% females) with CRC were included, including patients who traveled from their homes (group A) and those who rented apartments near the hospital to complete treatment (group B). Group A patients (N = 178) traveled a median of 22 kms (48 minutes) to reach the cancer center, while Group B patients (N = 85) resided a median of 75 kms (130 minutes) away from the hospital. Travel time did not correlate with symptom duration before diagnosis of CRC.In group A, patients with the highest travel burden (Q4 travel time) had poorer outcomes than other patients (Q1-Q3 of travel time) (18-month overall survival (OS) of 65% versus 83.6%, adjusted HR 2.5 (95% CI 1.2 to 5.2)). 18-month OS in group B was higher than that for group A patients (85.6% versus 78.9%, p = 0.056). Conclusion: Our study demonstrates that travel burden is associated with poorer outcomes in patients with CRC.
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