The effects of distance from primary treatment centers on survival among patients with multiple myeloma.

Abstract

Twenty-one comprehensive cancer centers participated in a national reporting system of common data items, recording information on all patients seen between 1977 and 1982. There were 240,531 patients who had data abstracted. This report describes 1,479 patients with multiple myeloma. Parameters that may effect the type of treatment given during the initial episode of therapy in the center and the effect of these characteristics on survival were studied. In the univariate analysis, age, treatment, and distance traveled to the center were statistically associated with survival. In a multivariate analysis adjusting for potentially confounding covariates, blacks survive better than whites and the effects of sex and socioeconomic status (SES) on survival approach significance. Survival consistently improved with increasing distance traveled to treatment centers. This may be a serious confounding variable in assessing the results by both single and multiinstitution clinical trials.

Socioeconomic status is independently associated with overall survival in patients with multiple myeloma

“…Lenhard, et al (1987) reported on 1,479 newly diagnosed MM patients enrolled into the Centralized Cancer Patient Data System (CCPDS), a NCI supported multi-center collaborative database, between 1977 and 1982 19 . The investigators used the percentage of the population in each patient’s home zip code that were high school graduates during the 1970 census as a surrogate for SES.…”

Conventional induction treatments do not influence overall survival in multiple myeloma

“…We have no data in this setting: patient management seems quite similar in all the haematological institutions involved into the study. However, this a very complex matter; even the distance from the reference centre has been shown to be a significant factor in patient survival (Lenhart et al, 1987).…”

Distance to Diagnosing Provider as a Measure of Access for Patients With Melanoma

“…These cases may represent statistical outliers, or they may be systematically different from the remainder of the population. Studies 15,24 have shown a protective benefit for patients who travel long distances; it is theorized that these cases represent the most empowered patients, who are not hindered by barriers such as travel distance.…”

“…Although increased travel distance is generally viewed as a barrier to screening, early diagnosis, and treatment, previous studies 15,17,[23][24][25] examining the role of travel distance for patients with cancer have had mixed results. We hypothesize that for patients with melanoma greater distance to a diagnosing provider is associated with increased Breslow thickness or stage at diagnosis.…”