Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience

Abstract

Purpose Patient travel time can cause treatment delays when providers and families decide to seek proton therapy. We examined whether travel distance or referral pattern (domestic versus international) affects time to radiation therapy and subsequent disease outcomes in patients with medulloblastoma at a large academic proton center. Patients and Methods Children with medulloblastoma treated at MD Anderson (MDA) with a protocol of proton beam therapy (PBT) between January 4, 2007, and June 25, 2014, were included in the analysis. The Wilcoxon rank-sum test was used to study the association between time to start of radiation and distance. Classification- and regression-tree analyses were used to explore binary thresholds for continuous covariates (ie, distance). Failure-free survival was defined as the time interval between end of radiation and failure or death. Results 96 patients were included in the analysis: 17 were international (18%); 19 (20%) were from Houston, Texas; 21 were from other cities inside Texas (21%); and 39 (41%) were from other US states. The median time from surgery to start of radiation was not significantly different for international patients (median = 1.45 months) compared with US patients (median = 1.15 months; P = .13). However, time from surgery to start of radiation was significantly longer for patients residing > 1716 km (> 1066 miles) from MDA (median = 1.31 months) than for patients residing ≤ 1716 km (≤ 1066 miles) from MDA (median = 1.05 months; P = .01). This 1- to 2-week delay (median = 7.8 days) did not affect failure-free survival (hazard ratio = 1.34; P = .43). Conclusion We found that short delays in proton access can exist for patients traveling long distances to proton centers. However, in this study, treatment delays did not affect outcomes. This highlights the appropriateness of PBT in the face of travel coordination. Investment by proton centers in a rigorous intake process is justified to offer timely access to curative PBT.

Predictors of time to definitive surgery and survival in Merkel cell carcinoma: analysis of the US National Cancer Database

“…In terms of treatment factors, there was a significant difference between the type of treatment facility at which patients and their eventual TTI. Patients treated at community programmes received treatment sooner than those treated at academic centres, possibly due to the travel arrangements necessary for patients to be treated at larger academic centres compared with the local proximity of many community‐based programmes 15 . However, academic institutions have been shown to be the more cost‐effective option of the two, with tangible survival differences being observed at academic institutions for cancers of the head and neck, often due to additional clinical expertise 16 …”

“…Patients treated at community programmes received treatment sooner than those treated at academic centres, possibly due to the travel arrangements necessary for patients to be treated at larger academic centres compared with the local proximity of many community-based programmes. 15 However, academic institutions have been shown to be the more cost-effective option of the two, with tangible survival differences being observed at academic institutions for cancers of the head and neck, often due to additional clinical expertise. 16 The type of surgery also predicted TTI, with faster receipt of care for patients receiving local tumour excision (LTE) than WLE, the mainstay surgical treatment for MCC.…”

Factors Associated With Travel Distance in the Receipt of Proton Breast Radiation Therapy

“…Numerous publications on travel distances to receive PBT demonstrate the field's interest in this topic and the magnitude of travel some patients experience to receive treatment. A study conducted at the MD Anderson Cancer Center, where nearly one-third of hospital admissions are from out-of-state patients as it is a destination treatment center, found the median travel distance to receive PBT for medulloblastoma was 1008 miles [ 11 ]. Another study at the Washington University School of Medicine showed that cancer patients traveled significantly more for proton than photon therapy, with mean distances of 83.3 and 47.4 miles, respectively [ 13 ].…”

“…Travel distance from RT facilities has been demonstrated to be a barrier to recommended care [ 10 ]. Despite this, patients may be willing to travel long distances for PBT given the potential clinical and dosimetric advantages not available at their local radiation centers [ 11 – 14 ]. Patients may also be interested in proton clinical trials and may be referred by formal and informal networks for special circumstances, such as re-irradiation.…”

Health Care Transition for Adolescents and Young Adults With Pediatric‐Onset Liver Disease and Transplantation

“…With continued program development and outcomes monitoring during transition and after transfer, it will be important to assess the educational topics and interventions that can affect outcomes after transfer to adult providers. Recommendations for topics to be included in educational sessions with HCT based on current literature are included in Table 3 (29,33,(40)(41)(42).…”