Abstract
Background
The impact of distance traveled on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) outcomes needs further investigation.
Methods
This retrospective study reviewed a prospectively managed single-center CRS/HIPEC 1992–2022 database. Zip codes were used to calculate distance traveled and to obtain data on income and education via census data. Patients were separated into three groups based on distance traveled in miles (local: ≤50 miles, regional: 51–99 miles, distant: ≥100 miles). Descriptive statistics, Kaplan-Meier method, and Cox regression were performed.
Results
The 1614 patients in the study traveled a median distance of 109.5 miles (interquartile range [IQR], 53.36–202.29 miles), with 23% traveling locally, 23.9% traveling regionally, and 53% traveling distantly. Those traveling distantly or regionally tended to be more white (distant: 87.8%, regional: 87.2%, local: 83.2%), affluent (distant: $61,944, regional: $65,014, local: $54,390), educated (% without high school diploma: distant: 10.6%, regional: 11.5%, local: 13.0%), less often uninsured (distant: 2.3%, regional: 4.6%, local: 5.2%) or with Medicaid (distant: 3.3%, regional: 1.3%, local: 9.7%). They more often had higher Peritoneal Carcinomatosis Index (PCI) scores (distant: 15.4, regional: 15.8, local: 12.7) and R2 resections (distant: 50.3%, regional: 52.2%, local: 40.5%). Median survival did not differ between the groups, and distance traveled was not a predictor of survival.
Conclusion
More than 50% of the patients traveled farther than 100 miles for treatment. Although regionalization of CRS/HIPEC may be appropriate given the lack of survival difference based on distance traveled, those who traveled further had fewer health care disparities but higher PCI scores and more R2 resections, which raises concerns about access to care for the underserved, time to treatment, and surgical quality.
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Acknowledgments
The authors acknowledge the support of the Wake Forest Baptist Comprehensive Cancer Center Biostatistics Shared Resource by the National Cancer Institute’s Cancer Center Support Grant (award no. P30CA012197). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.
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Poster presentations at the 2023 Advanced Cancer Therapies meeting, San Diego, California, 18–20 February 202,3 and the Society for Surgical Oncology International Conference on Surgical Cancer Care at Boston, Massachusetts, 22–25 March 2023.
Appendix
Appendix
Tables
4,
5,
6 and Figs.
Overall survival curves based on distance traveled (1992–2001)
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Overall survival curves based on distance traveled (2002–2011)
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Overall survival curves based on distance traveled (2012–2022)
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Solsky, I., Patel, A., Leonard, G. et al. Distance Traveled and Disparities in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 31, 1035–1048 (2024). https://doi.org/10.1245/s10434-023-14469-1
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DOI: https://doi.org/10.1245/s10434-023-14469-1