Login to Access Video or Poster Abstract: MP96-07
Sources of Funding: none

Introduction

Regionalization of cystectomy has been associated with improved outcomes but it may exacerbate geographic disparity by increasing travel distance. We sought to examine the association between travel distance to a high-volume cystectomy center and the probability of receiving a cystectomy among patients with muscle-invasive bladder cancer._x000D_

Methods

Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients diagnosed with non-metastatic muscle-invasive bladder cancer between 2004 and 2011. We further identified patient treatment (i.e, cystectomy, bladder-sparing alternative) using the inpatient, outpatient, and carrier files. Patients were then grouped into quartiles according to travel distance to the nearest high-volume cystectomy center (<=8, 9-22, 23-53, and >53 miles). High-volume cystectomy centers included those with cystectomy volumes in the top quartile. The relationship between distance to a high-volume cystectomy center and treatment was assessed using a multivariable logistic regression model, adjusting for age, sex, race, comorbidity, marital status, county population, education level and median household income in ZIP code of residence, grade, and stage.

Results

Among 5149 patients with non-metastatic muscle-invasive bladder cancer, 1998 (39%) underwent a radical cystectomy. The adjusted probability of receiving a cystectomy according to travel distance to a high-volume cystectomy center is summarized in Figure 1. Compared to patients with a travel distance of 8 miles or less, those with a travel distance of 9-22 miles were less likely to receive a cystectomy (adjusted OR 0.79, 95% CI 0.66-0.96). However, this difference was mitigated in those with travel distances beyond 22 miles

Conclusions

Our findings demonstrated a complex relationship between travel distances to a high-volume cystectomy center and the probability of receiving a radical cystectomy. While increasing distance decreased the likelihood of receiving a cystectomy for patients that live easily commutable distance, this disparity dissipated once the travel distance increased beyond 22 miles.

Funding

none