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Health Policy. 2018 Sep;122(9):1028-1034. doi: 10.1016/j.healthpol.2018.07.002. Epub 2018 Jul 6.

Centralisation of cancer surgery and the impact on patients' travel burden.

Author information

Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands. Electronic address:


Recent years have seen increasing trends towards centralisation of complex medical procedures, including cancer surgery. The impact of these trends on patients' travel burden is often ignored. This study charts the effects of different scenarios of centralising surgery on the travel burden for patients with cancer of the digestive tract, particularly among vulnerable patient groups. Our analyses include all surgically treated Dutch patients with colorectal, stomach or oesophageal cancer diagnosed in 2012-2013. After determining each patient's actual travel burden, simulations explored the impact of continued centralisation of cancer surgery under four hypothetical scenarios. Compared to patients' actual travelling, simulated travel distances under relatively 'conservative' scenarios did not necessarily increase, most likely due to current hospital bypassing. Using multivariable regression analyses, as a first exercise, it is examined whether the potential effects on travel burden differ across patient groups. For some cancer types, under more extreme scenarios increases in travel distances are significantly higher for older patients and those with a low SES. Given the potential impact on vulnerable patients' travel burden, our analysis suggests a thorough consideration of non-clinical effects of centralisation in health policy.


Cancer surgery; Centralisation; Travel burden

[Indexed for MEDLINE]

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