Original Study| Volume 15, ISSUE 6, P689-695.e2, December 2017

Association of Distance to Treatment Facility With Survival and Quality Outcomes After Radical Cystectomy: A Multi-Institutional Study



      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.


      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.


      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.


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        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2016.
        CA Cancer J Clin. 2016; 16: 7-30
        • Clark P.E.
        • Agarwal N.
        • Biagioli M.C.
        • et al.
        Bladder cancer.
        J Natl Compr Canc Netw. 2013; 11: 446-475
        • Shabsigh A.
        • Korets R.
        • Vora K.C.
        • et al.
        Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology.
        Eur Urol. 2009; 55: 164-174
        • Birkmeyer J.D.
        • Stukel T.A.
        • Siewers A.E.
        • Goodney P.P.
        • Wennberg D.E.
        • Lucas F.L.
        Surgeon volume and operative mortality in the United States.
        N Engl J Med. 2003; 349: 2117-2127
        • Birkmeyer J.D.
        • Siewers A.E.
        • Finlayson E.V.
        • et al.
        Hospital volume and surgkical mortality in the United States.
        N Engl J Med. 2002; 346: 1128-1137
        • Hollenbeck B.K.
        • Taub D.A.
        • Miller D.C.
        • Dunn R.L.
        • Montie J.E.
        • Wei J.T.
        The regionalization of radical cystectomy to specific medical centers.
        J Urol. 2005; 174: 1385-1389
        • Haddad A.Q.
        • Singla N.
        • Gupta N.
        • et al.
        Association of distance to treatment facility on quality and survival outcomes after radical cystectomy for bladder cancer.
        Urology. 2015; 85: 876-882
        • Casey M.F.
        • Gross T.
        • Wisnivesky J.
        • Stensland K.D.
        • Oh W.K.
        • Galsky M.D.
        The impact of regionalization of cystectomy on racial disparities in bladder cancer care.
        J Urol. 2015; 194: 36-41
        • Gore J.L.
        • Lai J.
        • Setodji C.M.
        • Litwin M.S.
        • Saigal C.S.
        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
        • Gore J.L.
        • Litwin M.S.
        • Lai J.
        • et al.
        Use of radical cystectomy for patients with invasive bladder cancer.
        J Natl Cancer Inst. 2010; 102: 802-811
        • Konety B.R.
        • Allareddy V.
        • Modak S.
        • Smith B.
        Mortality after major surgery for urologic cancers in specialized urology hospitals: are they any better?.
        J Clin Oncol. 2006; 24: 2006-2012
        • Ravi P.
        • Bianchi M.
        • Hansen J.
        • et al.
        Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis.
        BJU Int. 2014; 113: 733-740
        • Stitzenberg K.B.
        • Chang Y.
        • Smith A.B.
        • Nielsen M.E.
        Exploring the burden of inpatient readmissions after major cancer surgery.
        J Clin Oncol. 2015; 33: 455-464
        • Grossman H.B.
        • Natale R.B.
        • Tangen C.M.
        • et al.
        Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer.
        N Engl J Med. 2003; 349: 859-866
        • Rose T.L.
        • Deal A.M.
        • Basch E.
        • et al.
        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