Christopher B Anderson1, Renee Gennarelli2, Harry W Herr3, Elena B Elkin2. 1. Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: cba2125@cumc.columbia.edu. 2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. 3. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Abstract
PURPOSE: Radical cystectomy (RC) has become increasingly regionalized to high-volume hospitals. Our objective was to describe changes in regional market concentration and the distribution of RCs among hospitals, and examine how these changes affect patient travel distance to surgery. MATERIALS AND METHODS: We used the surveillance, epidemiology, and end results-Medicare database to identify patients who had RC for bladder cancer from 2001 to 2011. We defined RC market concentration within each Hospital Referral Regions (HRR) in surveillance, epidemiology, and end results using the Hirschman-Herfindhal Index. We measured straight-line patient travel distance to the nearest cystectomy provider hospital and used linear regression to evaluate the effect of market concentration on travel distance for surgery. We performed a similar analysis on patients who had laparoscopic cholecystectomy as a comparator. RESULTS: We identified 10,802 patients with bladder cancer who had RC. From 2001 to 2011, 40% of HRRs had a statistically significant increase in Hirschman-Herfindhal Index, 53% had no significant change and 7% had a statically significant decrease. The median patient travel distance increased significantly from 10.4 miles (interquartile range: 2.6-30.2) to 16 miles (interquartile range: 6.3-40.4, P<0.0001). Patients who lived in a highly concentrated HRR had to travel significantly further than patients who lived in an unconcentrated HRR (β = 37.5, P<0.001). These trends were not seen for laparoscopic cholecystectomy. CONCLUSIONS: Between 2001 and 2011, RC became increasingly regionalized to a small group of hospitals with a resultant increase in regional RC market concentration and patient travel distance. The clinical consequences on these changes to patients who require RC are uncertain.
PURPOSE: Radical cystectomy (RC) has become increasingly regionalized to high-volume hospitals. Our objective was to describe changes in regional market concentration and the distribution of RCs among hospitals, and examine how these changes affect patient travel distance to surgery. MATERIALS AND METHODS: We used the surveillance, epidemiology, and end results-Medicare database to identify patients who had RC for bladder cancer from 2001 to 2011. We defined RC market concentration within each Hospital Referral Regions (HRR) in surveillance, epidemiology, and end results using the Hirschman-Herfindhal Index. We measured straight-line patient travel distance to the nearest cystectomy provider hospital and used linear regression to evaluate the effect of market concentration on travel distance for surgery. We performed a similar analysis on patients who had laparoscopic cholecystectomy as a comparator. RESULTS: We identified 10,802 patients with bladder cancer who had RC. From 2001 to 2011, 40% of HRRs had a statistically significant increase in Hirschman-Herfindhal Index, 53% had no significant change and 7% had a statically significant decrease. The median patient travel distance increased significantly from 10.4 miles (interquartile range: 2.6-30.2) to 16 miles (interquartile range: 6.3-40.4, P<0.0001). Patients who lived in a highly concentrated HRR had to travel significantly further than patients who lived in an unconcentrated HRR (β = 37.5, P<0.001). These trends were not seen for laparoscopic cholecystectomy. CONCLUSIONS: Between 2001 and 2011, RC became increasingly regionalized to a small group of hospitals with a resultant increase in regional RC market concentration and patient travel distance. The clinical consequences on these changes to patients who require RC are uncertain.
Authors: Łukasz Zapała; Aleksander Ślusarczyk; Bartłomiej Korczak; Paweł Kurzyna; Mikołaj Leki; Piotr Lipiński; Jerzy Miłow; Michał Niemczyk; Kamil Pocheć; Michał Późniak; Maciej Przudzik; Tomasz Suchojad; Rafał Wolański; Piotr Zapała; Tomasz Drewa; Marek Roslan; Waldemar Różański; Andrzej Wróbel; Piotr Radziszewski Journal: Front Oncol Date: 2022-01-26 Impact factor: 6.244