Travelling to a High-Volume Center Confers Improved Survival in Stage I Non-small Cell Lung Cancer.

Autor:	Muslim Z; Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, Connecticut. Electronic address: zaid.muslim@nuvancehealth.org., Baig MZ; Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, Connecticut., Weber JF; Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, Connecticut., Connery CP; Division of Thoracic Surgery, Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York., Bhora FY; Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, Connecticut.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2022 Feb; Vol. 113 (2), pp. 466-472. Date of Electronic Publication: 2021 Mar 01.
DOI:	10.1016/j.athoracsur.2021.02.028
Abstrakt:	Background: The association of hospital volume with outcomes has been assessed previously for patients with non-small cell lung cancer (NSCLC), but there are 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: Outcomes of interest were compared between 2 propensity-matched groups with stage I NSCLC: patients 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). Outcomes included type of resection (anatomic or nonanatomic), time to resection (< or ≥8 weeks), number of lymph nodes examined (< or ≥10 nodes) and R0 resection. Results: We identified 3325 Local patients who travelled 2.3 miles (interquartile range [IQR]: 1.4-3.3 miles) to centers that treated 10.5 (IQR: 6.5-16.5) stage I NSCLCs/year and 3361 Distant patients who travelled 40.0 miles (IQR: 29.1-63.4 miles) to centers treating 56.9 (IQR: 40.1-84.7) stage I NSCLCs/year. Local patients were less likely to receive surgery <8 weeks post-diagnosis, have ≥10 lymph nodes examined during surgery, and undergo an R0 resection (all P < .01). Distant patients had shorter hospital stays and superior median survival, both P < .01. Conclusions: Patients travelling longer distances to high-volume centers receive better and more timely surgical care, leading to shorter hospital stays and improved survival outcomes. Regionalization of lung cancer care by improving travel support to larger treatment facilities may help improve early-stage NSCLC outcomes. (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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