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The Association between Mortality and Distance to Treatment Facility in Patients with Muscle Invasive Bladder Cancer
Stephen Ryan1, Emily C Serrell2, Patrick Karabon3
1Division of Urology, Maine Medical Center, Portland, Maine.
The Journal of Urology
|October 15, 2017
Summary
Patients traveling farther for invasive bladder cancer treatment did not have worse survival. Treatment at academic centers was linked to reduced mortality, suggesting regionalization may improve outcomes.
Area of Science:
- Urology
- Oncology
- Health Services Research
Background:
- Regionalization of bladder cancer care aims to enhance quality.
- Increased travel distances for treatment may impact patient outcomes.
- The implications of travel distance on mortality are not fully understood.
Purpose of the Study:
- To analyze the association between travel distance and overall mortality in patients with invasive bladder cancer.
- To investigate this relationship in patients undergoing radical cystectomy.
Main Methods:
- Retrospective cohort study using the National Cancer Database (2004-2012).
- Included patients with muscle-invasive bladder cancer (cT2a-T4 N0 M0) and a subgroup who had radical cystectomy.
- Multivariate Cox proportional hazards and logistic regression analyses were performed, controlling for confounders.
Main Results:
- Longer travel distances for muscle-invasive bladder cancer were associated with lower overall mortality, particularly for cT2 disease and academic center treatments.
- For radical cystectomy patients, this trend was not statistically significant.
- Increased travel distance correlated with treatment at high-volume centers and neoadjuvant chemotherapy receipt.
Conclusions:
- Traveling farther for bladder cancer treatment did not lead to worse survival.
- Treatment at academic institutions was associated with reduced mortality.
- Findings suggest a complex interplay between regionalization, patient behavior, and healthcare seeking in bladder cancer care.