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

Ahmed Q. Haddad, Ryan Craig Hutchinson, Erika L. Wood, Gus Miranda, Boris Gershman, Jamie Messer, Robert Svatek, Peter C. Black, Stephen A. Boorjian, Jay Shah, Siamak Daneshmand, Yair Lotan

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
DOIs
StateAccepted/In press - Jan 31 2017

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Cystectomy
Survival
Mortality
Therapeutics
Healthcare Disparities
Quality of Health Care
Tertiary Healthcare
Urinary Bladder Neoplasms
Tertiary Care Centers
Neoplasms
Multivariate Analysis
Odds Ratio
Confidence Intervals
Carcinoma

Keywords

  • Bladder cancer
  • Morbidity
  • Neoadjuvant chemotherapy
  • Regionalization
  • Travel

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Association of Distance to Treatment Facility With Survival and Quality Outcomes After Radical Cystectomy : A Multi-Institutional Study. / Haddad, Ahmed Q.; Hutchinson, Ryan Craig; Wood, Erika L.; Miranda, Gus; Gershman, Boris; Messer, Jamie; Svatek, Robert; Black, Peter C.; Boorjian, Stephen A.; Shah, Jay; Daneshmand, Siamak; Lotan, Yair.

In: Clinical Genitourinary Cancer, 31.01.2017.

Research output: Contribution to journalArticle

Haddad, Ahmed Q. ; Hutchinson, Ryan Craig ; Wood, Erika L. ; Miranda, Gus ; Gershman, Boris ; Messer, Jamie ; Svatek, Robert ; Black, Peter C. ; Boorjian, Stephen A. ; Shah, Jay ; Daneshmand, Siamak ; Lotan, Yair. / Association of Distance to Treatment Facility With Survival and Quality Outcomes After Radical Cystectomy : A Multi-Institutional Study. In: Clinical Genitourinary Cancer. 2017.
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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.",
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AU - Haddad, Ahmed Q.

AU - Hutchinson, Ryan Craig

AU - Wood, Erika L.

AU - Miranda, Gus

AU - Gershman, Boris

AU - Messer, Jamie

AU - Svatek, Robert

AU - Black, Peter C.

AU - Boorjian, Stephen A.

AU - Shah, Jay

AU - Daneshmand, Siamak

AU - Lotan, Yair

PY - 2017/1/31

Y1 - 2017/1/31

N2 - 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.

AB - 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.

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KW - Morbidity

KW - Neoadjuvant chemotherapy

KW - Regionalization

KW - Travel

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