长途跋涉治疗直肠癌：机构结果和患者体验。

Traveling Long Distances for Rectal Cancer Care: Institutional Outcomes and Patient Experiences.

机构信息

Division of Colon and Rectal Surgery, Department of Surgery, Milwaukee, Wisconsin.

Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.

出版信息

J Surg Res. 2024 Oct;302:916-924. doi: 10.1016/j.jss.2024.07.123. Epub 2024 Sep 11.

DOI:10.1016/j.jss.2024.07.123

PMID:39265279

Abstract

INTRODUCTION

Mounting evidence supports traveling to high-volume centers for complex surgical procedures, such as a proctectomy, yet the burden of travel and outcomes of patients traveling long distances is not yet clear. Thus, we aimed to evaluate oncologic outcomes, quality of life, and travel burdens for patients treated for rectal cancer at a single tertiary-care institution.

METHODS

A retrospective study of patients treated with proctectomy for locally advanced rectal cancer was performed comparing long and short travel distance (STD) cohorts. Primary outcome measures included overall mortality, disease recurrence, and quality of life. Secondary outcomes included out-of-pocket expenses. The cohorts were compared using Wilcoxon rank-sum and Chi-square tests for continuous and categorical variables, respectively. Kaplan-Meier plots were created to evaluate overall and disease-free survival.

RESULTS

Among 102 patients, 51 (50%) were classified as long travel distance (LTD, mean 57.8 miles) and 51 (50%) were classified as STD (mean 12.8 miles). There was no statistical difference in 5-y mortality (4% LTD versus 4% STD, P = 1.000), disease recurrence (26% LTD versus 18% STD, P = 0.336), or quality of life (0.85 LTD versus 0.87 STD, P = 0.690). The LTD cohort did have significantly lower postresection compliance with surveillance (84% LTD versus 96% STD, P = 0.046). LTD cohort also had significantly more lodging ($77.1 LTD versus $0 STD, P = 0.025) and transportation expenses ($133.6 LTD versus $92.6 STD, P = 0.010).

CONCLUSIONS

As the surgical management of rectal cancer becomes increasingly centralized, this study found patients who traveled long-distances received comparable care with outcomes similar to those who lived locally. Higher travel costs and lower compliance with surveillance were identified as barriers to care in the long-distance population, but a number of solutions can be implemented to address these issues.

摘要

简介

越来越多的证据表明，对于复杂的手术程序（如直肠切除术），前往高容量的中心是有益的，但患者长途旅行的负担和结果尚不清楚。因此，我们旨在评估在一家三级保健机构接受治疗的直肠癌患者的肿瘤学结果、生活质量和旅行负担。

方法

对接受直肠切除术治疗局部晚期直肠癌的患者进行回顾性研究，比较长途和短距离旅行（STD）队列。主要观察指标包括总死亡率、疾病复发和生活质量。次要结果包括自付费用。分别使用 Wilcoxon 秩和检验和卡方检验比较连续变量和分类变量。绘制 Kaplan-Meier 图以评估总体和无病生存率。

结果

在 102 名患者中，51 名（50%）被归类为长途旅行距离（LTD，平均 57.8 英里），51 名（50%）被归类为 STD（平均 12.8 英里）。5 年死亡率（LTD 为 4%，STD 为 4%，P=1.000）、疾病复发率（LTD 为 26%，STD 为 18%，P=0.336）或生活质量（LTD 为 0.85，STD 为 0.87，P=0.690）无统计学差异。LTD 组术后接受监测的依从性明显较低（LTD 为 84%，STD 为 96%，P=0.046）。LTD 组的住宿费用（LTD 为 77.1 美元，STD 为 0 美元，P=0.025）和交通费用（LTD 为 133.6 美元，STD 为 92.6 美元，P=0.010）明显更高。