Sean T Massa1, Adam P Liebendorfer2, Jose P Zevallos1, Angela L Mazul1. 1. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA. 2. Washington University School of Medicine, St Louis, Missouri, USA.
Abstract
OBJECTIVE: Improved head and neck cancer survival has been associated with traveling farther distances for treatment, potentially due to patients seeking higher-quality facilities. This study investigates the role of both facility and confounding patient factors on this relationship. STUDY DESIGN: Review of national registry data. SETTING: National Cancer Database. SUBJECTS AND METHODS: Adults with head and neck cancer diagnosed from 2004 to 2014 were identified. Overall survival was compared among distance-to-facility quartiles via univariate and multivariate survival models. Then, the analysis was stratified by facility and patient factors, and the association between distance and survival was compared among strata. RESULTS: Overall survival was worst in the shortest-distance quartile (<5 miles; median survival, 80.7 months; 95% CI, 79.2-82.3), while other distance groups showed similar survival (range, 96.4-104 months). This finding remained in the multivariate model (adjusted hazard ratio vs first distance quartile: 0.88; 95% CI, 0.87-0.89). The association between survival and distance persisted in all subgroups when stratified by facility volume and type (adjusted hazard ratio range, 0.82-0.91), suggesting that facility quality does not fully account for this association. When stratified by income, distance remained statistically associated with survival but with a smaller effect size than that of income. CONCLUSION: The association between distance to treating facility and head and neck cancer survival is limited to patients with worse survival outcomes living within 5 miles of the facility and is not fully explained by measures of facility quality.
OBJECTIVE: Improved head and neck cancer survival has been associated with traveling farther distances for treatment, potentially due to patients seeking higher-quality facilities. This study investigates the role of both facility and confounding patient factors on this relationship. STUDY DESIGN: Review of national registry data. SETTING: National Cancer Database. SUBJECTS AND METHODS: Adults with head and neck cancer diagnosed from 2004 to 2014 were identified. Overall survival was compared among distance-to-facility quartiles via univariate and multivariate survival models. Then, the analysis was stratified by facility and patient factors, and the association between distance and survival was compared among strata. RESULTS: Overall survival was worst in the shortest-distance quartile (<5 miles; median survival, 80.7 months; 95% CI, 79.2-82.3), while other distance groups showed similar survival (range, 96.4-104 months). This finding remained in the multivariate model (adjusted hazard ratio vs first distance quartile: 0.88; 95% CI, 0.87-0.89). The association between survival and distance persisted in all subgroups when stratified by facility volume and type (adjusted hazard ratio range, 0.82-0.91), suggesting that facility quality does not fully account for this association. When stratified by income, distance remained statistically associated with survival but with a smaller effect size than that of income. CONCLUSION: The association between distance to treating facility and head and neck cancer survival is limited to patients with worse survival outcomes living within 5 miles of the facility and is not fully explained by measures of facility quality.
Entities:
Keywords:
National Cancer Database; access to care; disparities; distance to provider; head and neck cancer
Authors: Amarbir S Gill; Daniel M Beswick; Jess C Mace; Dennis Menjivar; Shaelene Ashby; Ryan A Rimmer; Vijay R Ramakrishnan; Zachary M Soler; Jeremiah A Alt Journal: JAMA Otolaryngol Head Neck Surg Date: 2022-06-01 Impact factor: 8.961
Authors: Marc A Emerson; Douglas R Farquhar; Nicholas R Lenze; Siddharth Sheth; Angela L Mazul; Adam M Zanation; Trevor G Hackman; Mark C Weissler; Jose P Zevallos; Wendell G Yarbrough; Paul Brennan; Behnoush Abedi-Ardekani; Andrew F Olshan Journal: Head Neck Date: 2022-01-19 Impact factor: 3.147