Association of Distance to Treatment Facility on Quality and Survival Outcomes After Radical Cystectomy for Bladder Cancer

• Published in: Urology (Ridgewood, N.J.) N.J.), 2015-04, Vol.85 (4), p.876-882
• Main Authors: Haddad, Ahmed Q, Singla, Nirmish, Gupta, Neil, Raj, Ganesh V, Sagalowsky, Arthur I, Margulis, Vitaly, Lotan, Yair
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma - mortality; Carcinoma - therapy; Chemotherapy, Adjuvant - utilization; Cystectomy - methods; Cystectomy - mortality; Female; Health Services Accessibility - statistics & numerical data; Humans; Male; Middle Aged; Neoadjuvant Therapy - utilization; Quality of Health Care; Survival Rate; Time-to-Treatment - standards; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - surgery; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2014.12.024

Objective To examine the association of travel distance on quality and survival outcome measures for bladder cancer patients undergoing radical cystectomy for urothelial carcinoma. Methods Four hundred eight patients who underwent radical cystectomy for bladder cancer at a single institution from 2007 to 2013 were included. Multivariate logistic regression was used to determine the association of distance from treatment facility with 90-day mortality and quality-of-care endpoints including neoadjuvant chemotherapy use and time to cystectomy. Survival was assessed by multivariate Cox regression. Results Fifty-seven percent of patients lived within 50 miles of the treatment facility. There was no difference in time to cystectomy or the utilization of neoadjuvant chemotherapy between patients in different distance groups. On multivariate analysis, distance to treatment facility was the only predictor of 90-day mortality (odds ratio, 11.20; 95% confidence interval, 2.27-55.43; P  = .003, for patients traveling >150 vs 150 vs