Stephen Ryan1, Emily C Serrell2, Patrick Karabon3, Gregory Mills4, Moritz Hansen5, Matthew Hayn2, Mani Menon3, Quoc-Dien Trinh6, Firas Abdollah3, Jesse D Sammon7. 1. Division of Urology, Maine Medical Center, Portland, Maine. 2. Tufts University School of Medicine, Boston, Massachusetts. 3. Vattikutti Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan. 4. Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine. 5. Division of Urology, Maine Medical Center, Portland, Maine; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine; Tufts University School of Medicine, Boston, Massachusetts. 6. Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 7. Division of Urology, Maine Medical Center, Portland, Maine; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine; Tufts University School of Medicine, Boston, Massachusetts. Electronic address: jsammon@mmc.org.
Abstract
PURPOSE: Regionalization of bladder cancer treatment is suggested to improve quality of care. As an unintended consequence some patients travel farther for care with unknown implications on outcomes. We characterized the relationship between distance and overall mortality in patients with invasive bladder cancer and those who underwent radical cystectomy. MATERIALS AND METHODS: We performed a retrospective cohort study using NCDB (National Cancer Database) from 2004 to 2012 to identify patients with muscle invasive bladder cancer (cT2a-T4 N0 M0). We also extracted a subgroup of patients who underwent radical cystectomy. Multivariate Cox proportional hazards and multinomial logistic regression analyses were performed in each group, controlling for demographic, clinical, hospital and geographic factors. RESULTS: For 34,729 patients with muscle invasive bladder cancer traveling farther for treatment was associated with a lower probability of overall mortality (referent less than 12.5 miles, 12.5 to 49.9 miles HR 0.96, 95% CI 0.92-0.99 and 50 to 249.9 miles HR 0.91, 95% CI 0.86-0.96). This was significant for patients with cT2 disease and those treated at academic centers (p ≤0.05). For 11,059 patients who underwent radical cystectomy this trend did not reach significance. However, longer distance was associated with surgery at a high volume institution and receipt of neoadjuvant chemotherapy (each p <0.001). CONCLUSIONS: Patients who traveled farther for bladder cancer treatment did not experience inferior survival outcomes and traveling to academic institutions was associated with reduced mortality. For patients who undergo cystectomy this relationship was equivocal, although longer distance was associated with receiving neoadjuvant chemotherapy or surgery at a high volume facility. These findings may reflect a complex association of regionalization of bladder cancer care with patient individual health and health care seeking behavior.
PURPOSE: Regionalization of bladder cancer treatment is suggested to improve quality of care. As an unintended consequence some patients travel farther for care with unknown implications on outcomes. We characterized the relationship between distance and overall mortality in patients with invasive bladder cancer and those who underwent radical cystectomy. MATERIALS AND METHODS: We performed a retrospective cohort study using NCDB (National Cancer Database) from 2004 to 2012 to identify patients with muscle invasive bladder cancer (cT2a-T4 N0 M0). We also extracted a subgroup of patients who underwent radical cystectomy. Multivariate Cox proportional hazards and multinomial logistic regression analyses were performed in each group, controlling for demographic, clinical, hospital and geographic factors. RESULTS: For 34,729 patients with muscle invasive bladder cancer traveling farther for treatment was associated with a lower probability of overall mortality (referent less than 12.5 miles, 12.5 to 49.9 miles HR 0.96, 95% CI 0.92-0.99 and 50 to 249.9 miles HR 0.91, 95% CI 0.86-0.96). This was significant for patients with cT2 disease and those treated at academic centers (p ≤0.05). For 11,059 patients who underwent radical cystectomy this trend did not reach significance. However, longer distance was associated with surgery at a high volume institution and receipt of neoadjuvant chemotherapy (each p <0.001). CONCLUSIONS:Patients who traveled farther for bladder cancer treatment did not experience inferior survival outcomes and traveling to academic institutions was associated with reduced mortality. For patients who undergo cystectomy this relationship was equivocal, although longer distance was associated with receiving neoadjuvant chemotherapy or surgery at a high volume facility. These findings may reflect a complex association of regionalization of bladder cancer care with patient individual health and health care seeking behavior.
Authors: Joshua Sterling; Zorimar Rivera-Núñez; Hiren V Patel; Nicholas J Farber; Sinae Kim; Kushan D Radadia; Parth K Modi; Sharad Goyal; Rahul Parikh; Robert E Weiss; Isaac Y Kim; Sammy E Elsamra; Thomas L Jang; Eric A Singer Journal: Clin Genitourin Cancer Date: 2020-03-20 Impact factor: 2.872
Authors: Beth Russell; Christel Häggström; Lars Holmberg; Fredrik Liedberg; Truls Gårdmark; Richard T Bryan; Pardeep Kumar; Mieke Van Hemelrijck Journal: BJUI Compass Date: 2021-01-07