Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes

Xu, Zhaomin; Becerra, Adan Z.; Justiniano, Carla F.; Boodry, Courtney I.; Aquina, Christopher T.; Swanger, Alex A.; Temple, Larissa K.; Fleming, Fergal J.

doi:10.1097/dcr.0000000000000924

Cited by 67 publications

(60 citation statements)

References 19 publications

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“…In the international literature, a wide range of categories are used for rectal cancer volume at hospital level. Van Gijn et al calculated median cut-off points from published rectal cancer hospital volume studies, leading to a definition of a high-volume hospital a performing more than 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) rectal cancer resections per year and low-volume hospitals performing 9 (6-14) [28]. This hampers interpretation of the available literature on this topic.…”

Section: Discussionmentioning

confidence: 99%

International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

et al. 2019

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Aim This study aimed to determine predictive factors for the circumferential resection margin (CRM) within two northern European countries with supposed similarity in providing rectal cancer care. Method Data for all patients undergoing rectal resection for clinical tumour node metastasis (TNM) stage I–III rectal cancer were extracted from the Swedish ColoRectal Cancer Registry and the Dutch ColoRectal Audit (2011–2015). Separate analyses were performed for cT1–3 and cT4 stage. Predictive factors for the CRM were determined using univariable and multivariable logistic regression analyses. Results A total of 6444 Swedish and 12 089 Dutch patients were analysed. Over time the number of hospitals treating rectal cancer decreased from 52 to 42 in Sweden, and 82 to 79 in the Netherlands. In the Swedish population, proportions of cT4 stage (17% vs 8%), multivisceral resection (14% vs 7%) and abdominoperineal excision (APR) (37% vs 31%) were higher. The overall proportion of patients with a positive CRM (CRM+) was 7.8% in Sweden and 5.4% in the Netherlands. In both populations with cT1–3 stage disease, common independent risk factors for CRM+ were cT3, APR and multivisceral resection. No common risk factors for CRM+ in cT4 stage disease were found. An independent impact of hospital volume on CRM+ could be demonstrated for the cT1–3 Dutch population. Conclusion Within two northern European countries with implemented clinical auditing, rectal cancer care might potentially be improved by further optimizing the treatment of distal and locally advanced rectal cancer.

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Section: Discussionmentioning

confidence: 99%

International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

et al. 2019

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“…The volume‐outcome relationship related to complex surgical procedures has been well‐documented . In the current centers, it was interesting to note that destination PD hospitals were likely to be academic medical centers, had more mean annual admissions, more hospital beds, more operating rooms, as well as more full time nurses (Table ).…”

Section: Discussionmentioning

confidence: 91%

“…The volume-outcome relationship related to complex surgical procedures has been well-documented. [13][14][15] In the current centers, it was interesting to note that destination PD hospitals were likely to be academic medical centers, had more mean annual admissions, more hospital beds, more operating rooms, as well as more full time nurses ( Table 2). In aggregate, patients who bypassed a closer hospital to be treated at a destination had lower peri-operative morbidity and failure-to-rescue, as well as an incidence of perioperative mortality that was almost one-half lower.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] These high-volume centers are often located, however, in urban areas, which compounded by the closure of existing rural hospital-based surgical services, may hinder rural community access to high-quality surgical care. 13,[15][16][17] For example, although the number of hospitals that provided surgical services with an approved American College of Surgeons (ACS) cancer program slightly increased since 2005, the number of people living greater than 60 minutes has increased from 6% to 11%. 18 The call to centralize complex surgical procedures, including operations associated with cancer treatment, to high-volume centers has the potential to create a significant barrier of increased travel burden on potentially vulnerable populations.…”

Section: Introductionmentioning

confidence: 99%

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Accessing surgical care for pancreaticoduodenectomy: Patient variation in travel distance and choice to bypass hospitals to reach higher volume centers

Díaz

Burns

Paredes

2019

Journal of Surgical Oncology

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Background While better outcomes at high‐volume surgical centers have driven regionalization of complex surgical care, access to high‐volume centers often requires travel over longer distances. We sought to evaluate travel patterns of patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer to assess willingness of patients to travel for surgical care. Methods The California Office of Statewide Health Planning database was used to identify patients who underwent PD between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed PD to get to a higher‐volume center was assessed. Multivariate analyses were used to identify factors associated with bypassing a local hospital for a higher‐volume center. Results Among 23 014 patients who underwent PD, individuals traveled a median distance of 18.0 miles to get to a hospital that performed PD. The overwhelming majority (84%) of patients bypassed the nearest providing hospital and traveled a median additional 16.6 miles to their destination hospital. Among patients who bypassed the nearest hospital, 13,269 (68.6%) did so for a high‐volume destination hospital. Specifically, average annual PD volume at the nearest “bypassed” vs final destination hospital was 29.6 vs 56 cases, respectively. Outcomes at bypassed vs destination hospitals varied (incidence of complications: 39.2% vs 32.4%; failure‐to‐rescue: 14.5% vs 9.1%). PD at a high‐volume center was associated with lower mortality (OR = 0.46 95% CI, 0.22‐0.95). High‐volume PD ( > 20 cases) was predictive of hospital bypass (OR = 3.8 95% CI, 3.3‐4.4). Among patients who had surgery at a low‐volume center, nearly 20% bypassed a high‐volume hospital in route. Furthermore, among patients who did not bypass a high‐volume hospital, one‐third would have needed to travel only an additional 30 miles or less to reach the nearest high‐volume hospital. Conclusion Most patients undergoing PD bypassed the nearest providing hospital to seek care at a higher‐volume hospital. While these data reflect increased regionalization of complex surgical care, nearly 1 in 5 patients still underwent PD at a low‐volume center.

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“…While distance traveled has been studied in the context of surgical outcomes, its influence on clinical decision‐making is not well defined . It is often thought that patients travel for care when “local” expertise is not available, particularly when their disease requires complex decision‐making.…”

Section: Introductionmentioning

confidence: 99%

Receipt of sentinel lymph node biopsy for thin melanoma is associated with distance traveled for care

Kang

Columbo

Trooboff

et al. 2018

Journal of Surgical Oncology

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Background Sentinel lymph node biopsy (SLNB) is not routinely recommended for thin melanoma. However, it is considered when high‐risk features, clinicopathological, or sociodemographic, are present. It was our objective to evaluate the impact of travel distance on decision‐making for SLNB in thin melanoma. Methods We used the National Cancer DataBase (1998‐2011) to identified patients with thin melanoma (≤1 mm thickness). The primary exposure was distance traveled for care, categorized as short (<12.5 miles), intermediate (12.5‐49.9 miles), or long (≥50 miles). The primary outcome was receipt of SLNB. Results We identified 21 124 cases of thin melanoma; 48.8%, 38.2%, and 13.0% traveled short, intermediate, and long distances, respectively. Overall, SLNB was performed in 32.8% of patients. Traveling farther was associated with a step‐wise increase in the likelihood of undergoing a SLNB (P‐trend < 0.001). Even after adjusting for patient, disease, and facility factors, we found that patients who traveled an intermediate distance were 18% more likely to undergo a SLNB (OR:1.18; 95%CI: 1.10,1.27), and those who traveled a long distance were 24% more likely (OR:1.24; 95%CI: 1.11,1.39) compared with those who traveled a short distance. Conclusions The distance patients travel for surgical care appears to be an independent factor influencing the receipt of SLNB.

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Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes

Cited by 67 publications

References 19 publications

International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

Accessing surgical care for pancreaticoduodenectomy: Patient variation in travel distance and choice to bypass hospitals to reach higher volume centers

Receipt of sentinel lymph node biopsy for thin melanoma is associated with distance traveled for care

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