Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Cancer. 2017 Sep 1;123(17):3241-3252. doi: 10.1002/cncr.30744. Epub 2017 May 4.
The objective of this study was to investigate the impact of travel distance to the treating facility on the risk of overall mortality (OM) among US patients with prostate cancer (PCa).
In total, 775,999 patients who had PCa in all stages and received treatment with different strategies (radical prostatectomy, radiation therapy, observation, androgen-deprivation therapy, multimodal treatment, and chemotherapy) were drawn from the National Cancer Data Base from 2004 through 2012. Independent predictors of travel distance (intermediate [12.5-49.9 miles] and long [49.9-249.9 miles] vs short[<12.5 miles]) and its effect on OM were calculated using multivariable regression analyses. Additional analyses evaluated the distance effect on OM in selected subgroups.
In total, 54.5%, 33.4%, and 12.1% of patients traveled short, intermediate, and long distances, respectively. Residency in rural areas and the receipt of treatment at academic/high-volume centers independently predicted long travel distance. Non-Hispanic black men and Medicaid-insured men were less likely to travel long distances (all P < .001). Overall, traveling a long distance (hazard ratio, 0.87; 95% confidence interval, 0.83-0.92; P < .001) was associated with lower OM risk compared with traveling a short distance. This held true among non-Hispanic white men; privately insured and Medicare-insured men; those who underwent radical prostatectomy, received radiation therapy, and received multimodal strategies; and those who received treatment at academic/high-volume centers (P < .01), but not among non-Hispanic black men (P = .3). Long travel distance was associated with an increased OM in Medicaid-insured patients (P < .001).
An OM benefit was observed among men who traveled long distances for PCa treatment, which is likely to be a reflection of centralization of care and more favorable patient-level characteristics in those travelers. Furthermore, the survival benefit mediated by long travel distances appears to be influenced by baseline socioeconomic, treatment, and facility-level factors. Cancer 2017;123:3241-52. © 2017 American Cancer Society.
本研究旨在探讨美国前列腺癌（PCa）患者就诊距离对总死亡率（OM）的影响。
本研究从 2004 年至 2012 年，从国家癌症数据库中抽取了所有阶段接受不同治疗策略（前列腺切除术、放疗、观察、雄激素剥夺治疗、多模式治疗和化疗）的 775999 例 PCa 患者。使用多变量回归分析计算了就诊距离（中程[12.5-49.9 英里]和远程[49.9-249.9 英里]与短程[<12.5 英里]）的独立预测因素及其对 OM 的影响。另外的分析评估了距离对选定亚组 OM 的影响。
共有 54.5%、33.4%和 12.1%的患者分别短、中、长距离就诊。居住在农村地区和在学术/高容量中心接受治疗是长途旅行的独立预测因素。非西班牙裔黑人男性和医疗补助保险男性较少长途旅行（均 P<.001）。总体而言，与短距离旅行相比，长途旅行（风险比，0.87；95%置信区间，0.83-0.92；P<.001）与 OM 风险较低相关。这在非西班牙裔白人男性、私人保险和医疗保险男性、接受前列腺切除术、放疗和多模式治疗的男性以及在学术/高容量中心接受治疗的男性中是正确的（P<.01），但在非西班牙裔黑人男性中并非如此（P=.3）。长途旅行与医疗补助保险患者 OM 增加相关（P<.001）。
在接受 PCa 治疗的长途旅行男性中观察到 OM 获益，这可能反映了治疗的集中化以及这些旅行者的患者水平特征更为有利。此外，长途旅行所带来的生存获益似乎受到基线社会经济、治疗和设施水平因素的影响。癌症 2017；123：3241-52。©2017 美国癌症协会。
