{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:59:52Z","timestamp":1791399592816,"version":"4.3.3"},"reference-count":53,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR300599"],"award-info":[{"award-number":["NIHR300599"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2024,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>This national study investigated hospital quality and patient factors associated with treatment location for breast cancer surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>By using linked administrative data sets from the English National Health Service, the authors identified all women diagnosed between January 2, 2016, and December 31, 2018, who underwent breast\u2010conserving surgery (BCS) or a mastectomy with or without immediate breast reconstruction. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regressions were used to estimate the impact of travel time, hospital quality, and patient characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>22,622 Of 69,153 patients undergoing BCS, 22,622 (32.7%) bypassed their nearest hospital; and, of 23,536 patients undergoing mastectomy, 7179 (30.5%) bypassed their nearest hospital. Women who were younger, without comorbidities, or from rural areas were more likely to travel to more distant hospitals (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.05). Patients undergoing BCS (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.36\u20132.50) or mastectomy (OR, 1.52; 95% CI, 1.14\u20132.02) were more likely to be treated at specialist breast reconstruction centers despite not undergoing the procedure. Patients receiving mastectomy and immediate breast reconstruction were more likely to travel to hospitals employing surgeons who had a media reputation (OR, 2.41; 95% CI, 1.28\u20134.52). Patients undergoing BCS were less likely to travel to hospitals with shorter surgical waiting times (OR, 0.65; 95% CI, 0.46\u20130.92). The authors did not observe a significant impact for research activity, hospital quality rating, breast re\u2010excision rates, or the status as a multidisciplinary cancer center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patient choice policies may drive inequalities in the health care system without improving patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.35153","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T03:01:21Z","timestamp":1704682881000},"page":"1221-1233","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgery: A national population\u2010based study"],"prefix":"10.1002","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9645-6659","authenticated-orcid":false,"given":"Ajay","family":"Aggarwal","sequence":"first","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"Department of Oncology Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7198-3380","authenticated-orcid":false,"given":"Lu","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lewis","sequence":"additional","affiliation":[{"name":"UK Department for Environment, Food, and Rural Affairs Agriculture Ministry of the United Kingdom  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette","family":"Costigan","sequence":"additional","affiliation":[{"name":"Oxford Breast Buddy Group  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Hubbard","sequence":"additional","affiliation":[{"name":"Patient and Public Involvement Representative  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Taylor","sequence":"additional","affiliation":[{"name":"ABC Diagnosis  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Rigg","sequence":"additional","affiliation":[{"name":"Department of Oncology Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnie","family":"Purushotham","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust  London UK"},{"name":"School of Cancer and Pharmaceutical Sciences King\u2019s College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"van der Meulen","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2016.11.011"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1515\/9781400828005"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1257\/jel.53.2.235"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/eururo.2017.07.016"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.08.018"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.5461"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558716654631"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd004538.pub3"},{"key":"e_1_2_9_10_1","volume-title":"My Planned Care","author":"National Health Service (NHS) England","year":"2022"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010018\u20106825\u20107"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr31987"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2454"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.461"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6604531"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010016\u20105202\u20107"},{"key":"e_1_2_9_17_1","volume-title":"The NHS Choice Framework: what choices are available to me in the NHS?","author":"Department of Health","year":"2016"},{"key":"e_1_2_9_18_1","unstructured":"Department of Health and Social Care. NHS Constitution for England.National Health Service;2021."},{"key":"e_1_2_9_19_1","volume-title":"Hospital Episode Statistics (HES)","author":"NHS Digital","year":"2016"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2016.02.008"},{"key":"e_1_2_9_21_1","volume-title":"National Cancer Registration for England","author":"National Cancer Registration and Analysis Service","year":"2016"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6930"},{"key":"e_1_2_9_23_1","volume-title":"National Statistics; English indices of deprivation 2015","author":"Ministry of Housing, Communities & Local Government","year":"2015"},{"key":"e_1_2_9_24_1","volume-title":"Hospital Episode Statistics. The Office of Population, Censuses and Surveys (OPCS) Classification of Interventions and Procedures, 4th Revision (OPCS\u20104)","author":"NHS Digital","year":"2022"},{"key":"e_1_2_9_25_1","volume-title":"Census Geography","author":"Office for National Statistics","year":"2017"},{"key":"e_1_2_9_26_1","volume-title":"International Statistical Classification of Disease and Related Health Problems 10th Revision (ICD\u201010)","author":"World Health Organisation (WHO)","year":"2016"},{"key":"e_1_2_9_27_1","volume-title":"Urban and Rural Area Definitions for Policy Purposes in England and Wales. Methodology","author":"Bibby P","year":"2013"},{"key":"e_1_2_9_28_1","volume-title":"2018 Annual Report","author":"National Audit of Breast Cancer in Older Patients (NABCOP)","year":"2018"},{"key":"e_1_2_9_29_1","volume-title":"The good doctors guide: Meet the best breast surgeons for breast cancer","author":"Daily Mail Reporter","year":"2018"},{"key":"e_1_2_9_30_1","unstructured":"Care Quality Commission.Information to check hospitals in England and the quality of their care. Care Quality Commission;2022. Accessed May 10 2023.https:\/\/www.cqc.org.uk\/care\u2010services\/find\u2010hospital"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0118253"},{"key":"e_1_2_9_32_1","unstructured":"NHS England.Working together at scale: guidance on provider collaboratives. Publication PAR754. NHS England and NHS Improvement;2021."},{"key":"e_1_2_9_33_1","unstructured":"Office for National Statistics.Understanding consistency of ethnicity data recorded in health\u2010related administrative datasets in England: 2011 to 2021. UK Statistics Authority;2021."},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0977"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.12443"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2015.20"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.20.2244"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2008.20.1715"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102021\u2010054055"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2019.09.040"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrab126"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1470\u20102045(17)30572\u20107"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34504"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/sap.0000000000002575"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1089\/jayao.2018.0125"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102019\u2010009818"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2013.199"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102013\u2010004677"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905\u2010021\u201001352\u2010y"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102022\u2010071967"},{"key":"e_1_2_9_51_1","volume-title":"The NHS Long Term Plan","author":"National Health Service (NHS)","year":"2019"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/0277\u20109536(85)90385\u20105"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2018.03.009"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2012.02.001"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.35153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T13:44:24Z","timestamp":1760276664000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.35153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,8]]},"references-count":53,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,4,15]]}},"alternative-id":["10.1002\/cncr.35153"],"URL":"https:\/\/doi.org\/10.1002\/cncr.35153","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,8]]},"assertion":[{"value":"2023-08-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}