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MP96-16: Association of travel distance, socioeconomic status, and referral institution on delay to definitive surgery in patients with bladder cancer

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

Presentation Authors: David Golombos*, New York, NY, Padraic O'Malley, Halifax, Canada, Patrick Lewicki, Abimbola Ayangbesan, LaMont Barlow, Douglas Scherr, New York, NY

Introduction: Treatment delay in patients with invasive bladder cancer negatively impacts survival. In rural settings, delays to definitive surgery are often associated with travel distance/burden. We examine factors associated with delay to radical cystectomy (RC) at an urban, tertiary referral center, where travel burden is less likely to represent a barrier to timely care.

Methods: IRB approved, retrospective review was performed on 383 consecutive non-metastatic patients who underwent definitive RC at a single National Cancer Institute (NCI) designated comprehensive care center between 2001-2014. Zip code derived proxies of socioeconomic status were collected in reference to patient primary residence using US Census data, in addition to characteristics of referring facilities including size, teaching status, and cancer center designation. Travel distance was estimated via straight line distance calculated from latitude and longitude. Multivariable logistic regression analysis was performed to identify factors associated with delay to cystectomy, defined as > 12 weeks from diagnosis of muscle invasive disease to RC. Patients residing outside the US were excluded from analysis.

Results: Twenty-two patients residing outside the US were excluded, leaving 363 patients for final analysis. Median travel distance was 15.1 miles, and median time from diagnosis to RC was 8 weeks. On multivariable analysis, referral from a non-NCI designated comprehensive care center (OR 3.1 95% CI [1.04 - 9.15] p=0.042), diagnosis outside of our hospital network (OR 5.5 95% CI [1.66 - 18.01] p=0.005), and receipt of neoadjuvant chemotherapy (OR 28 95% CI [14.1 - 56.2] p<0.001) were associated delay to RC. Patient age (p=.842), size of referring hospital (p=0.53), median household income (p=0.16) and estimated patient travel distance (p=0.41) were not associated with delay.

Conclusions: In an urban environment, distance to treatment facility was not associated with delay to RC. Delay was associated with characteristics referring institutions, including cancer center designation. Further investigation is warranted to determine if consolidation of care to designated centers for complex disease processes such as bladder cancer may improve patient outcomes.

Source Of Funding: None

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