Travel distance: Impact on stage of presentation and treatment choices in head and neck cancer

Ringstrom, Mark J.; Christian, W. Jay; Bush, Matthew L.; Levy, Jeffrey E.; Huang, Bin; Gal, Thomas J.

doi:10.1016/j.amjoto.2018.06.020

Cited by 26 publications

(36 citation statements)

References 13 publications

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“…White 2365 (30) 1429 (18) 1899 (24) 2073 (27) 1424 (20) 1552 (22) 1511 (22) 6976 Unknown 260 (32) 156 (19) 148 (18) 238 (30) 802 Unknown 139 (29) 74 (16) 103 (22) 156 ( 197 (19) 245 (23) 255 (24) patients with AML. For patients with ALL, this association holds for both children younger than 18 years and young adults aged 18 to 39 years.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, in some studies of adults with solid tumors, a longer distance to treatment centers seems to predict better outcomes. 20,21 For instance, among adults with head and neck cancer, those in the highest quartile for travel distance were more likely to present with early-stage disease, and those with oral cavity cancer were more likely to receive appropriate surgical therapy. 22 For men with prostate cancer, longer travel distances have been associated with decreased overall mortality except for those with Medicaid insurance.…”

Section: Continuedmentioning

confidence: 99%

“…Among adults with certain solid tumors, distance to treatment center is associated with outcomes. 20,21 We hypothesized that distance to treatment center affects outcomes of children and young adults with acute leukemia because a longer distance might strain families and caregivers to a greater degree and might lead to delays in seeking care both at diagnosis and for complications during treatment. To test our hypothesis, we queried the NCDB and developed models to predict the contribution of distance to treatment center to overall survival for children and AYAs with AML and ALL.…”

Section: Introductionmentioning

confidence: 99%

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Distance to treatment center is associated with survival in children and young adults with acute lymphoblastic leukemia

Rotz

Wei

Schlüter

et al. 2020

Cancer

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BACKGROUND: Socioeconomic and demographic categories such as income, race, insurance status, and treatment center type are associated with outcomes in acute leukemia. This study was aimed at determining whether the distance to treatment center affects overall survival for children and young adults with acute leukemia. METHODS: The National Cancer Database was queried for patients 39 years old or younger who were diagnosed with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). A backward elimination procedure was used to select final multivariate Cox models. RESULTS: In total, 12,301 patients with AML and 22,683 patients with ALL were analyzed. The ALL model included distance to treatment center, Charlson-Deyo score, age, race, insurance status, and community income level. US census definitions of urban and rural were not statistically significant, and no interaction was significant for included variables. Compared with distances > 50 miles, all other distances were associated with improved survival (hazard ratio [HR] for ≤10 miles, 0.91; P = .04; HR for >10 to ≤20 miles, 0.86; P = .004; HR for >20 to ≤50 miles, 0.87; P = .005). The final model for AML included the same variables as the ALL model except for distance to treatment center, which was not statistically significant. CONCLUSIONS: For children and young adults with ALL, distances > 50 miles are associated with inferior overall survival; however, no difference is seen for AML. Although it is unknown whether differences in survival for patients with ALL based on distance are driven by relapse or treatmentrelated mortality, increased attention to adherence, supportive care, and logistics for patients traveling long distances is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Continuedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distance to treatment center is associated with survival in children and young adults with acute lymphoblastic leukemia

Rotz

Wei

Schlüter

et al. 2020

Cancer

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“…Previous analyses have shown how demographic and socioeconomic markers such as insurance status, ethnicity, and hospital travel distance influence treatment access for head and neck cancer, and they have highlighted disparities in treatment access across the United States . Large database studies have found that patients with head and neck cancer with nonprivate insurance tend to receive care at hospitals with poorer outcomes in comparison with their privately insured counterparts .…”

Section: Discussionmentioning

confidence: 99%

“…9 Previous analyses have shown how demographic and socioeconomic markers such as insurance status, ethnicity, and hospital travel distance influence treatment access for head and neck cancer, and they have highlighted disparities in treatment access across the United States. [23][24][25][26][27] Large database studies have found that patients with head and neck cancer with nonprivate insurance tend to receive care at hospitals with poorer outcomes in comparison with their privately insured counterparts. 24 We observed that more upfront surgical therapy was seen in younger patients, female patients, patients with increased comorbidity scores, patients living in the Pacific regions of the United States, those traveling >25 miles for treatment, and patients treated at top-volume hospitals, regardless of whether they were academic or community institutions.…”

Section: Discussionmentioning

confidence: 99%

National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma

Zhan

Puram

et al. 2019

Cancer

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Background Human papillomavirus (HPV)–mediated oropharyngeal cancer (OPC) is associated with dramatically improved survival in comparison with HPV‐negative OPC and can be successfully treated with surgical and nonsurgical approaches. National treatment trends for OPC were investigated with the National Cancer Data Base (NCDB). Methods The NCDB was reviewed for primary HPV‐mediated OPC in 2010‐2014. Multivariable regression was used to identify predictors of both nonsurgical therapy and receipt of adjuvant chemoradiation (CRT). Results There were 13,363 patients identified with a median age at diagnosis of 58 years. The incidence of triple‐modality treatment (surgery with adjuvant chemotherapy) decreased from 23.7% in 2010 to 16.9% in 2014 (R2 = 0.96), whereas the incidence of nonsurgical treatment increased from 63.9% to 68.7% (R2 = 0.89). Hospitals in the top treatment volume quartile (quartile 1 [Q1]; n = 29) had a lower rate of positive margins (16.3%) than bottom‐quartile centers (n = 741; rate of positive margins, 36.4%; P < .001); Q1 hospitals used surgical therapy significantly more. Independent predictors of nonsurgical therapy included older age, advanced disease, lower hospital volume, and living closer to the hospital or outside the Pacific United States. In surgically treated patients, younger age, lower hospital volume, nodal disease, positive surgical margins, and extranodal extension (ENE) also predicted more adjuvant CRT use. Conclusions The use of upfront surgical treatment decreased from 2010 to 2014. Hospital volume shows a strong, inverse correlation with the rate of positive surgical margins. The upfront treatment strategy is predicted not only by staging but also by patient‐, geographic‐, and hospital‐specific factors. Lower hospital volume remains independently associated with increased triple‐modality therapy after adjustments for positive margins, ENE, and pathologic staging.

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Association of Demographic and Geospatial Factors With Treatment Selection for Laryngeal Cancer

Mazul

Puram

Pipkorn

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Guidelines for many head and neck cancers, especially laryngeal cancers, allow for multiple treatment options. Currently, inequitable provision of surgery may contribute to outcome disparities. However, the role of geospatial factors remains understudied.OBJECTIVE To assess the association between US geospatial factors and treatment selection for patients with laryngeal cancer. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective cohort study, patients diagnosed with laryngeal squamous cell carcinoma between January 1, 2004, and December 31, 2014, were identified from the Surveillance, Epidemiology, and End Results database. Adjusted odds ratios (aORs) for surgical treatment were generated from multivariable, hierarchical models to assess associations with oncologic, demographic, and county variables. Outlier US counties with the highest and lowest aORs were described. Data analysis was performed from April 29 to September 11, 2020.EXPOSURES County of residence. MAIN OUTCOMES AND MEASURESThe aORs for surgical treatment were generated from multivariable, hierarchical models. Outlier counties with the highest and lowest aORs are described. RESULTSThe cohort includes 21 289 patients (mean [SD] age, 63.6 [11.2] years; 17 214 [80.9%] male) in 598 counties. Most counties had no otolaryngologist (365 [61.0%]) or radiation oncologist (434 [72.6%]). Surgery rates varied from 7.1% to 85.7% among counties with at least 10 cases. After oncologic variables were controlled for, factors independently associated with surgical treatment included patient age (aOR [95% CI], 0.94; 0.91-0.98 per 10 years), marital status (single versus married: aOR [95% CI], 0.87 [0.79-0.97]), and county social deprivation index (aOR [95% CI], 0.98 [0.97-1.00 per 5 points]) but not physician number (Ն2 otolaryngologists: aOR [95% CI], 0.91 [0.75-1.11] vs Ն1 radiation oncologist: aOR [95% CI], 0.91; 0.75-1.11). The 5% of counties most likely to provide surgery (aOR, >1.23) were nearly all large metropolitan areas (2593 patients [93.3%]) and treated a disproportionately large number of patients (2778 [13.1%]). The 5% of counties least likely to provide surgery (aOR, <0.79) were also mostly large metropolitan areas (1676 patients [91.2%]) and treated a disproportionately large number of patients (1838 [8.6%]). Patients in counties least likely to provide surgery had inferior survival compared with those most likely to provide surgery (adjusted hazard ratio, 1.16; 95% CI, 1.00-1.35).CONCLUSIONS AND RELEVANCE These findings suggest that sociodemographic factors contribute to the wide variety in surgical treatment practices by county. The largest metropolitan counties were often outliers regarding their adjusted odds of surgical treatment. This finding is concerning for the counties least likely to provide surgery where survival is inferior.

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Travel distance: Impact on stage of presentation and treatment choices in head and neck cancer

Cited by 26 publications

References 13 publications

Distance to treatment center is associated with survival in children and young adults with acute lymphoblastic leukemia

Distance to treatment center is associated with survival in children and young adults with acute lymphoblastic leukemia

National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma

Association of Demographic and Geospatial Factors With Treatment Selection for Laryngeal Cancer

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