Abstract
Background
We sought to determine the effect of the travel distance on mortality and quality
outcomes after radical cystectomy in a large multi-institutional cohort.
Patients and Methods
A total of 3957 patients who had undergone radical cystectomy for urothelial carcinoma
at 6 North American tertiary care institutions were included. The association of travel
distance with quality-of-care endpoints, 90-day mortality, and long-term survival
were evaluated.
Results
The median patient age was 69 years (interquartile range, 61-76 years), and most patients
were men (80%). Most patients had clinical stage T2 (45.2%) and T1 (24.7%) tumors.
The median distance to the treatment facility was 102.9 miles (interquartile range,
24-271 miles). Patients residing in the first quartile of travel distance to treatment
facility (< 24 miles) had lower usage of neoadjuvant chemotherapy compared with patients
in the fourth distance quartile (adjusted odds ratio, 1.58; 95% confidence interval,
1.22-2.05; P = .001). Patients in the first distance quartile were also less likely to experience
a delay in time to cystectomy (> 3 months) compared with patients with a greater travel
distance (adjusted odds ratio, 0.673; 95% confidence interval, 0.532-0.851). Distance
to the treatment facility was not associated with 90-day mortality or cancer-specific
or all-cause mortality on multivariate analysis.
Conclusion
Despite the potential health care disparities for bladder cancer patients residing
distant to a regional surgical oncology facility, the study results suggest that the
travel distance is not a barrier to appropriate oncologic care at regional tertiary
care centers.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2016.CA Cancer J Clin. 2016; 16: 7-30
- Bladder cancer.J Natl Compr Canc Netw. 2013; 11: 446-475
- Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology.Eur Urol. 2009; 55: 164-174
- Surgeon volume and operative mortality in the United States.N Engl J Med. 2003; 349: 2117-2127
- Hospital volume and surgkical mortality in the United States.N Engl J Med. 2002; 346: 1128-1137
- The regionalization of radical cystectomy to specific medical centers.J Urol. 2005; 174: 1385-1389
- Association of distance to treatment facility on quality and survival outcomes after radical cystectomy for bladder cancer.Urology. 2015; 85: 876-882
- The impact of regionalization of cystectomy on racial disparities in bladder cancer care.J Urol. 2015; 194: 36-41
- Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a Surveillance, Epidemiology, and End Results–Medicare analysis.Cancer. 2009; 115: 988-996
- Use of radical cystectomy for patients with invasive bladder cancer.J Natl Cancer Inst. 2010; 102: 802-811
- Mortality after major surgery for urologic cancers in specialized urology hospitals: are they any better?.J Clin Oncol. 2006; 24: 2006-2012
- Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis.BJU Int. 2014; 113: 733-740
- Exploring the burden of inpatient readmissions after major cancer surgery.J Clin Oncol. 2015; 33: 455-464
- Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer.N Engl J Med. 2003; 349: 859-866
- Neoadjuvant chemotherapy administration and time to cystectomy for muscle-invasive bladder cancer: an evaluation of transitions between academic and community settings.Urol Oncol. 2015; 33: 386.e1-386.e6
Article info
Publication history
Published online: May 09, 2017
Accepted:
May 1,
2017
Received in revised form:
April 17,
2017
Received:
January 31,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
