Impact of travel distance to the treatment facility on overall mortality in US patients with prostate cancer.
Vetterlein MW, Loppenberg B, Karabon P, Dalela D, Jindal T, Sood A, Chun FK, Trinh QD, Menon M, and Abdollah F. Impact of travel distance to the treatment facility on overall mortality in US patients with prostate cancer. Cancer 2017; 123(17):3241-3252.
ACKGROUND: The objective of this study was to investigate the impact of travel distance to the treating facility on the risk of overall mortality (OM) among US patients with prostate cancer (PCa).
METHODS: In total, 775,999 patients who had PCa in all stages and received treatment with different strategies (radical prostatectomy, radiation therapy, observation, androgen-deprivation therapy, multimodal treatment, and chemotherapy) were drawn from the National Cancer Data Base from 2004 through 2012. Independent predictors of travel distance (intermediate [12.5-49.9 miles] and long [49.9-249.9 miles] vs short[<12.5 miles]) and its effect on OM were calculated using multivariable regression analyses. Additional analyses evaluated the distance effect on OM in selected subgroups.
RESULTS: In total, 54.5%, 33.4%, and 12.1% of patients traveled short, intermediate, and long distances, respectively. Residency in rural areas and the receipt of treatment at academic/high-volume centers independently predicted long travel distance. Non-Hispanic black men and Medicaid-insured men were less likely to travel long distances (all P < .001). Overall, traveling a long distance (hazard ratio, 0.87; 95% confidence interval, 0.83-0.92; P < .001) was associated with lower OM risk compared with traveling a short distance. This held true among non-Hispanic white men; privately insured and Medicare-insured men; those who underwent radical prostatectomy, received radiation therapy, and received multimodal strategies; and those who received treatment at academic/high-volume centers (P < .01), but not among non-Hispanic black men (P = .3). Long travel distance was associated with an increased OM in Medicaid-insured patients (P < .001).
CONCLUSIONS: An OM benefit was observed among men who traveled long distances for PCa treatment, which is likely to be a reflection of centralization of care and more favorable patient-level characteristics in those travelers. Furthermore, the survival benefit mediated by long travel distances appears to be influenced by baseline socioeconomic, treatment, and facility-level factors. Cancer 2017;123:3241-52. © 2017 American Cancer Society.
Medical Subject Headings
Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Early Detection of Cancer; Health Services Accessibility; Healthcare Disparities; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Neoplasm Staging; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prostatectomy; Prostatic Neoplasms; Radiotherapy; Registries; Retrospective Studies; Risk Assessment; Survival Analysis; Time Factors; Travel; Treatment Outcome; United States; Watchful Waiting