Login to Access Video or Poster Abstract: MP76-05
Sources of Funding: None

Introduction

Overall Survival for Muscle Invasive Bladder Cancer (MIBC) with Radical Cystectomy (RC) is improved with neoadjuvant chemotherapy and surgery in high-volume centers. However, concentration of care inadvertently increases the average travel distance for patients who may have a post-RC complication. Using data from the National Cancer Data Base (NCDB), we evaluated the association between increasing travel distance in patients undergoing RC and the likelihood of receiving high volume care, neoadjuvant chemotherapy and overall survival.

Methods

Data were obtained from NCDB 2004-13. Patients had MIBC (T2-T4a, N0, M0) treated with RC. Distance to treating facility was examined in 3 categories (<12.5, 12.5-49, 50-250 miles). Multivariate logistic regression analysis was preformed to examine the interaction between distance and overall survival, then to test receipt of neoadjuvant chemotherapy. Multinomial regression examined the interaction between travel distance and RC volume tertiles (<3, 3-6, >6 per year).

Results

11,059 patients treated with RC identified, including 2609 that had neoadjuvant chemotherapy. Hazard ratios for overall survival, receipt of neoadjuvant chemotherapy, as well as volume of RC are presented in Table 1. Overall survival was not associated with travel distance. As distance to facility increased, so did the likelihood that a patient received neoadjuvant chemotherapy. Increase in distance was also associated with facilities that had high volumes of RC.

Conclusions

As distance to treatment facility increased, the likelihood that a patient would receive neoadjuvant chemotherapy or have surgery at a high volume center also increased, supporting the relationship between concentration of care and quality. Nevertheless, overall survival was not affected by distance.

Funding

None