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The association between mortality and distance to treatment facility in patients with invasive bladder cancer

Login to Access Video or Poster Abstract: MP04-20
Sources of Funding: None

Introduction

Muscle-invasive bladder cancer (MIBC) and its treatment are associated with high morbidity and mortality. The concentration of care in tertiary centers is believed to improve patient outcomes but the potential negative impact of travel distance on quality of care and survival is unclear in MIBC as it may be associated with delay in diagnosis, decreased access to multimodal care and difficulty in managing the complications associated with care. Using data from the National Cancer Data Base (NCDB), we evaluated the association between distance to treating facility and overall mortality in patients with MIBC.

Methods

Data were obtained from NCDB 2004-13. We evaluated all cause mortality for patients with MIBC (T2-T4a, N0, M0), stratified by travel distance to treatment facility in 3 categories: <12.5, 12.5-49, 50-250 miles. Cox proportional hazard models were fit in the overall population, then in subgroups according to treatment facility type. A secondary analysis was done examining the interaction between distance and facility type.

Results

34,729 patients with MIBC identified. The three groups included 20,234 (58.3%), 10,400 (29.9%), 4,095 (11.9%) patients living <12.5, 12.5-49, 50-250 miles from their treatment facility, respectively. Kaplan -Meier curve constructed for overall survival separated by distance (Figure 1). HRs for distance and mortality are reported in table 1. There was a trend towards decreased probability of mortality as distance to facility increased; this relationship was significant when traveling a long distance for care at an academic facility .

Conclusions

Lengthy travel distance to treating facility was not associated with decreased survival in patients with MIBC. In contrast, travel distance was associated with improved overall survival if the treatment facility was an academic center.

Funding

None

Authors
Stephen Ryan
Patrick Karabon
Gregory Mills
Moritz Hansen
Matthew Hayn
Mani Menon
Quoc-Dien Trinh
Firas Abdollah
Jesse Sammon
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