Moderated Poster

Poster, Podium & Video Sessions

MP96-07: Patient Travel Distances To High-Volume Cystectomy Centers Follow A Complex Relationship

Tuesday, May 16
9:30 AM - 11:30 AM
Location: BCEC: Room 153

Presentation Authors: Nathan Hale*, Jonathan Yabes, Robert Turner, Mina Fam, Benjamin Davies, Bruce Jacobs, Pittsburgh, PA

Introduction: Regionalization of cystectomy has been associated with improved outcomes but it may exacerbate geographic disparity by increasing travel distance. We sought to examine the association between travel distance to a high-volume cystectomy center and the probability of receiving a cystectomy among patients with muscle-invasive bladder cancer.


Methods: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients diagnosed with non-metastatic muscle-invasive bladder cancer between 2004 and 2011. We further identified patient treatment (i.e, cystectomy, bladder-sparing alternative) using the inpatient, outpatient, and carrier files. Patients were then grouped into quartiles according to travel distance to the nearest high-volume cystectomy center (<=8, 9-22, 23-53, and >53 miles). High-volume cystectomy centers included those with cystectomy volumes in the top quartile. The relationship between distance to a high-volume cystectomy center and treatment was assessed using a multivariable logistic regression model, adjusting for age, sex, race, comorbidity, marital status, county population, education level and median household income in ZIP code of residence, grade, and stage.

Results: Among 5149 patients with non-metastatic muscle-invasive bladder cancer, 1998 (39%) underwent a radical cystectomy. The adjusted probability of receiving a cystectomy according to travel distance to a high-volume cystectomy center is summarized in Figure 1. Compared to patients with a travel distance of 8 miles or less, those with a travel distance of 9-22 miles were less likely to receive a cystectomy (adjusted OR 0.79, 95% CI 0.66-0.96). However, this difference was mitigated in those with travel distances beyond 22 miles

Conclusions: Our findings demonstrated a complex relationship between travel distances to a high-volume cystectomy center and the probability of receiving a radical cystectomy. While increasing distance decreased the likelihood of receiving a cystectomy for patients that live easily commutable distance, this disparity dissipated once the travel distance increased beyond 22 miles.

Source Of Funding: none

Nathan Hale, DO, MS

University of Pittsburgh

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