Travel Time to a High Volume Center Negatively Impacts Timing of Care in Rectal Cancer
| Autor: | Philip S. Bauer, Jonathan S. Abelson, Paul E. Wise, Christine Schad, Matthew G. Mutch, William C. Chapman, Sean C. Glasgow, John Barron, Matthew L. Silviera, Steven C. Hunt, Kerri A. Ohman, Radhika Smith |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Colorectal cancer Quality care Disease-Free Survival Health Services Accessibility Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Preoperative staging Primary outcome Humans Medicine Aged Quality of Health Care Retrospective Studies Travel Rectal Neoplasms business.industry General surgery Middle Aged medicine.disease Combined Modality Therapy Travel time Logistic Models 030220 oncology & carcinogenesis High volume center Rectal cancer surgery Female 030211 gastroenterology & hepatology Surgery business Hospitals High-Volume Follow-Up Studies Volume (compression) |
| Zdroj: | Journal of Surgical Research. 266:96-103 |
| ISSN: | 0022-4804 |
| Popis: | Regionalization of rectal cancer surgery may lead to worse disease free survival owing to longer travel time to reach a high volume center yet no study has evaluated this relationship at a single high volume center volume center.This was a retrospective review of rectal cancer patients undergoing surgery from 2009 to 2019 at a single high volume center. Patients were divided into two groups based on travel time. The primary outcome was disease-free survival (DFS). Additional outcomes included treatment within 60 d of diagnosis, completeness of preoperative staging, and evaluation by a colorectal surgeon prior to initiation of treatment.A lower proportion of patients with long travel time began definitive treatment within 60 d of diagnosis (74.0% versus 84.0%, P= 0.01) or were seen by the treating colorectal surgeon before beginning definitive treatment (74.8% versus 85.4%, P0.01). On multivariable logistic regression analysis, patients with long travel time were significantly less likely to begin definitive treatment within 60 d of diagnosis (OR = 0.54; 95% CI = 0.31-0.93) or to be evaluated by a colorectal surgeon prior to initiating treatment (OR = 0.45; 95% CI = 0.25-0.80). There were no significant differences in DFS based on travel time.Although patients with long travel times may be vulnerable to delayed, lower quality rectal cancer care, there is no difference in DFS when definitive surgery is performed at a high volume canter. Ongoing research is needed to identify explanations for delays in treatment to ensure all patients receive the highest quality care. |
| Databáze: | OpenAIRE |
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