Travel to a High-Volume Center Confers Improved Survival Outcomes in Early-Stage Non-Small Cell Lung Cancer
Zaid Muslim1, Mirza Zain Baig1, Juan Flores-Gonzalez1, Joanna Weber1, Cliff Connery2, Faiz Bhora1
1Nuvance Health, Danbury, CT, USA, 2Nuvance Health, Poughkeepsie, NY, USA
OBJECTIVE:The association of hospital volume with outcomes has been assessed previously for patients with non-small cell lung cancer (NSCLC), but there is limited data on the cumulative effect of travel burden and hospital volume on treatment decisions and survival outcomes. We used the National Cancer Database to evaluate this relationship in early-stage NSCLC.
METHODS: Multivariate logistic regression was used to identify predictors of the following surgical best practices in stage I NSCLC: surgery <8 weeks post-diagnosis, anatomic resection, sampling ≥10 lymph nodes and R0 resection. Outcomes were compared between propensity score-matched groups: those in the bottom quartile of distance travelled who underwent surgery at low-volume centers (Local) and those in the top quartile of distance travelled who received surgery at high-volume centers (Distant).
RESULTS: We identified 2988 (48.3%) Local patients who travelled 2.3 miles (IQR: 1.3-3.3) to centers that treated 3.5 (IQR: 2.3-4.3) stage I NSCLCs/year and 3203 (51.7%) Distant patients who travelled 45.9 miles (IQR: 31.9-76.7) to centers treating 21.2 (IQR: 18.0-32.0) stage I NSCLCs/year. Local patients were less likely to receive surgery <8 weeks post-diagnosis (OR: 0.28, 0.22-0.36) or have ≥10 lymph nodes sampled during surgery (OR: 0.73, 0.63-0.85), both p<0.001. Distant patients had shorter hospital stays (mean: 5.3 days vs. 6.8 days) and superior 30-day mortality (1.4% vs. 2.6%) and 5-year survival (71.8% vs. 64.7%), all p<0.001.
CONCLUSIONS:Compared to those seeking care nearby at low-volume hospitals, patients traveling longer distances to high-volume centers receive better and more timely surgical care, leading to shorter hospital stays and improved survival outcomes.
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