Association of Distance Traveled for Surgery with Short- and Long-Term Cancer Outcomes

Nabil Wasif, Yu Hui Chang, Barbara A Pockaj, Richard J. Gray, Amit Mathur, David Etzioni

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: The influence of distance traveled for treatment on short- and long-term cancer outcomes is unclear. Methods: Patients with colon, esophageal, liver, and pancreas cancer from 2003 to 2006 were identified from the National Cancer Data Base (NCDB). Distance traveled for surgical treatment was estimated using zip code centroids. Propensity scores were generated for probability of traveling farther for treatment. Mixed effects logistic regression for 90-day mortality and Cox regression for 5-year mortality were compared between patients treated regionally and those traveling from farther away. Results: The mean distance traveled for all patients for surgical resection was 30.0 ± 227 miles, with a median distance of 7.5 (interquartile range 14.4) miles. Patients who were aged ≥80 years, on Medicaid, or African American were less likely to be in the fourth quartile of distance (Q4) traveled for surgery. Patients who were in Q4 had a lower risk-adjusted 90-day mortality compared to Q1 for colon [odds ratio (OR) 0.89, 95 % confidence interval (CI) 0.82–0.96], liver (OR 0.49, 95 % CI 0.3–0.78), and pancreatic (OR 0.74, 95 % CI 0.56–0.98) cancer. Similarly, patients in Q4 for all tumor types had a lower risk-adjusted 5-year mortality compared to patients in Q1; colon (hazard ratio (HR) 0.96, 95 % CI 0.93–0.99), esophagus (HR 0.84, 95 % CI 0.75–0.94), liver (HR 0.75, 95 % CI 0.62–0.89), and pancreas (HR 0.87, 95 % CI 0.80–0.95). Conclusions: Greater travel distance for surgical resection of gastrointestinal cancers is associated with lower 90-day and 5-year mortality outcomes. This distance bias has implications for regionalization and reporting of cancer outcomes.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Apr 28 2016

Fingerprint

Confidence Intervals
Neoplasms
Mortality
Odds Ratio
Colon
Propensity Score
Gastrointestinal Neoplasms
Liver
Medicaid
Liver Neoplasms
Esophageal Neoplasms
Pancreatic Neoplasms
African Americans
Colonic Neoplasms
Esophagus
Pancreas
Therapeutics
Logistic Models
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Association of Distance Traveled for Surgery with Short- and Long-Term Cancer Outcomes. / Wasif, Nabil; Chang, Yu Hui; Pockaj, Barbara A; Gray, Richard J.; Mathur, Amit; Etzioni, David.

In: Annals of Surgical Oncology, 28.04.2016, p. 1-9.

Research output: Contribution to journalArticle

@article{6c57ced070bc4114ad06d7d5620e88e8,
title = "Association of Distance Traveled for Surgery with Short- and Long-Term Cancer Outcomes",
abstract = "Background: The influence of distance traveled for treatment on short- and long-term cancer outcomes is unclear. Methods: Patients with colon, esophageal, liver, and pancreas cancer from 2003 to 2006 were identified from the National Cancer Data Base (NCDB). Distance traveled for surgical treatment was estimated using zip code centroids. Propensity scores were generated for probability of traveling farther for treatment. Mixed effects logistic regression for 90-day mortality and Cox regression for 5-year mortality were compared between patients treated regionally and those traveling from farther away. Results: The mean distance traveled for all patients for surgical resection was 30.0 ± 227 miles, with a median distance of 7.5 (interquartile range 14.4) miles. Patients who were aged ≥80 years, on Medicaid, or African American were less likely to be in the fourth quartile of distance (Q4) traveled for surgery. Patients who were in Q4 had a lower risk-adjusted 90-day mortality compared to Q1 for colon [odds ratio (OR) 0.89, 95 {\%} confidence interval (CI) 0.82–0.96], liver (OR 0.49, 95 {\%} CI 0.3–0.78), and pancreatic (OR 0.74, 95 {\%} CI 0.56–0.98) cancer. Similarly, patients in Q4 for all tumor types had a lower risk-adjusted 5-year mortality compared to patients in Q1; colon (hazard ratio (HR) 0.96, 95 {\%} CI 0.93–0.99), esophagus (HR 0.84, 95 {\%} CI 0.75–0.94), liver (HR 0.75, 95 {\%} CI 0.62–0.89), and pancreas (HR 0.87, 95 {\%} CI 0.80–0.95). Conclusions: Greater travel distance for surgical resection of gastrointestinal cancers is associated with lower 90-day and 5-year mortality outcomes. This distance bias has implications for regionalization and reporting of cancer outcomes.",
author = "Nabil Wasif and Chang, {Yu Hui} and Pockaj, {Barbara A} and Gray, {Richard J.} and Amit Mathur and David Etzioni",
year = "2016",
month = "4",
day = "28",
doi = "10.1245/s10434-016-5242-z",
language = "English (US)",
pages = "1--9",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",

}

TY - JOUR

T1 - Association of Distance Traveled for Surgery with Short- and Long-Term Cancer Outcomes

AU - Wasif, Nabil

AU - Chang, Yu Hui

AU - Pockaj, Barbara A

AU - Gray, Richard J.

AU - Mathur, Amit

AU - Etzioni, David

PY - 2016/4/28

Y1 - 2016/4/28

N2 - Background: The influence of distance traveled for treatment on short- and long-term cancer outcomes is unclear. Methods: Patients with colon, esophageal, liver, and pancreas cancer from 2003 to 2006 were identified from the National Cancer Data Base (NCDB). Distance traveled for surgical treatment was estimated using zip code centroids. Propensity scores were generated for probability of traveling farther for treatment. Mixed effects logistic regression for 90-day mortality and Cox regression for 5-year mortality were compared between patients treated regionally and those traveling from farther away. Results: The mean distance traveled for all patients for surgical resection was 30.0 ± 227 miles, with a median distance of 7.5 (interquartile range 14.4) miles. Patients who were aged ≥80 years, on Medicaid, or African American were less likely to be in the fourth quartile of distance (Q4) traveled for surgery. Patients who were in Q4 had a lower risk-adjusted 90-day mortality compared to Q1 for colon [odds ratio (OR) 0.89, 95 % confidence interval (CI) 0.82–0.96], liver (OR 0.49, 95 % CI 0.3–0.78), and pancreatic (OR 0.74, 95 % CI 0.56–0.98) cancer. Similarly, patients in Q4 for all tumor types had a lower risk-adjusted 5-year mortality compared to patients in Q1; colon (hazard ratio (HR) 0.96, 95 % CI 0.93–0.99), esophagus (HR 0.84, 95 % CI 0.75–0.94), liver (HR 0.75, 95 % CI 0.62–0.89), and pancreas (HR 0.87, 95 % CI 0.80–0.95). Conclusions: Greater travel distance for surgical resection of gastrointestinal cancers is associated with lower 90-day and 5-year mortality outcomes. This distance bias has implications for regionalization and reporting of cancer outcomes.

AB - Background: The influence of distance traveled for treatment on short- and long-term cancer outcomes is unclear. Methods: Patients with colon, esophageal, liver, and pancreas cancer from 2003 to 2006 were identified from the National Cancer Data Base (NCDB). Distance traveled for surgical treatment was estimated using zip code centroids. Propensity scores were generated for probability of traveling farther for treatment. Mixed effects logistic regression for 90-day mortality and Cox regression for 5-year mortality were compared between patients treated regionally and those traveling from farther away. Results: The mean distance traveled for all patients for surgical resection was 30.0 ± 227 miles, with a median distance of 7.5 (interquartile range 14.4) miles. Patients who were aged ≥80 years, on Medicaid, or African American were less likely to be in the fourth quartile of distance (Q4) traveled for surgery. Patients who were in Q4 had a lower risk-adjusted 90-day mortality compared to Q1 for colon [odds ratio (OR) 0.89, 95 % confidence interval (CI) 0.82–0.96], liver (OR 0.49, 95 % CI 0.3–0.78), and pancreatic (OR 0.74, 95 % CI 0.56–0.98) cancer. Similarly, patients in Q4 for all tumor types had a lower risk-adjusted 5-year mortality compared to patients in Q1; colon (hazard ratio (HR) 0.96, 95 % CI 0.93–0.99), esophagus (HR 0.84, 95 % CI 0.75–0.94), liver (HR 0.75, 95 % CI 0.62–0.89), and pancreas (HR 0.87, 95 % CI 0.80–0.95). Conclusions: Greater travel distance for surgical resection of gastrointestinal cancers is associated with lower 90-day and 5-year mortality outcomes. This distance bias has implications for regionalization and reporting of cancer outcomes.

UR - http://www.scopus.com/inward/record.url?scp=84964433362&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964433362&partnerID=8YFLogxK

U2 - 10.1245/s10434-016-5242-z

DO - 10.1245/s10434-016-5242-z

M3 - Article

C2 - 27126630

AN - SCOPUS:84964433362

SP - 1

EP - 9

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

ER -