UCLA David Geffen School of Medicine/UCLA Medical Center Los Angeles, CA
M. A. Eala1,2, E. A. S. Maslog2, N. R. I. Alberto2, I. R. I. Alberto2, F. D. V. Ho2, E. C. Dee3, A. Raldow1, and R. E. Cereno4; 1Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 2College of Medicine, University of the Philippines, Manila, Philippines, 3Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 4Asian Hospital and Medical Center, Manila, Philippines
Purpose/Objective(s):Travel burden, defined as travel time, distance, and cost, negatively impacts the diagnosis, treatment, and quality of life of patients with cancer. Patients receiving radiotherapy often suffer from a significant travel burden given the daily protracted course of most treatment regimens. In low- and middle-income countries (LMICs), travel burden is magnified due to the lack and inequitable distribution of radiotherapy facilities. We evaluated the utility of Google Maps in measuring radiotherapy travel burden in the Philippines, a lower-middle income country in Southeast Asia with 117 million people and more than 7000 islands, where cancer is the second leading cause of death. Materials/
Methods: We used Google Maps to determine travel distance, time, and cost from city halls/provincial capitols to the nearest radiotherapy facility across all 17 regions in the Philippines. We also identified the nearest government radiotherapy facility, as many Filipino patients cannot afford the out-of-pocket costs at private facilities. We estimated travel cost by multiplying travel distance to the local price of diesel per liter and the mean fuel economy of passenger vehicles in the Philippines. Results: In 2022, the Philippines had 54 radiotherapy facilities (0.5 per 1M population), with more than a third located in the National Capital Region. 72% were private facilities. Four of 17 regions did not have a single radiotherapy facility. Two provinces, Marinduque and Romblon, had no identifiable route to a radiotherapy facility via land, sea, or air. 19 provinces required travel by ferry, and one province required travel by flight. The average distance to any radiotherapy facility was 101.02 kilometers (63 miles), with a travel time of 2.7 hours, and a one-way travel cost of $86 by private vehicle. Access to a government radiotherapy facility was more burdensome, with an average distance of 136.94 kilometers (85 miles), a travel time of 3.1 hours, and a one-way travel cost of $113 by private vehicle. Conclusion: The travel burden of radiotherapy in the Philippines is significant. Strategic installation of radiotherapy facilities must be carefully considered, with emphasis on developing more government facilities to ensure financially accessible cancer care. Google Maps lacked data on public transportation costs in the Philippines, reflecting the urgent need to organize and bolster public transportation in the country and ease travel burden on patients without private vehicles. In this study, we have successfully shown that Google Maps can be utilized in LMICs to quantify travel burden, identify radiotherapy ‘deserts’, and guide local radiotherapy infrastructure development.
