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Residential distance from the reporting hospital and survival among adolescents, and young adults diagnosed with CNS tumors

Abstract

Purpose

Prior research shows that residential distance to a treatment facility may be an important factor in central nervous system (CNS) tumor outcomes. Our goal was to examine residential distance to the reporting hospital and overall survival in adolescents and young adults (AYA) diagnosed with CNS tumors.

Methods

National Cancer Database data on AYA 15–39 years old diagnosed with CNS and Other Intracranial and Intraspinal Neoplasms (CNS tumors) from 2010 to 2014 were obtained. Distance between the case’s residence at diagnosis or initial treatment and the reporting hospital was classified in miles as short (≤ 12.5), intermediate (> 12.5 and < 50), and long (≥ 50). Cox proportional hazards regression models were used for analyses.

Results

Among 9335 AYA diagnosed with CNS tumors, hazard ratios (HRs) were 1.06 (95% CI 0.96–1.17) and 0.82 (95% CI 0.73–0.93) for those with residences at intermediate and long vs. short distances, respectively, after adjusting for age, sex, race/ethnicity, and zip-code level education and income. After adjusting for the facility volume of CNS tumor patients, the association was attenuated for long vs. short distance residences (HR 0.92, 95% CI 0.81–1.04). The HRs varied by tumor type, race/ethnicity, and zip-code level income with significantly lower hazards of death for those with residences at long vs. short distances for low-grade astrocytic tumors, ependymomas, non-Hispanic Whites, and those from higher-income areas.

Conclusions

Living at long distances for CNS tumor care may be associated with better survival in AYA patients. This may be explained by travel to facilities with more experience treating CNS tumors.

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Data availability

The data are available upon approval of the National Cancer Database.

Code availability

https://github.com/kijohnson/CNS-AYA-distance-paper.

References

  1. United States and Puerto Rico Cancer Statistics, 1999–2017 Incidence Results Form. https://wonder.cdc.gov/controller/datarequest/D160. Accessed 24 Jun 2021

  2. United States and Puerto Rico Cancer Statistics, 1999–2017 Mortality Results. https://wonder.cdc.gov/controller/datarequest/D161;jsessionid=0B249DF9306326570EF1E71EF64F?stage=results&action=sort&direction=MEASURE_DESCEND&measure=D161.M1. Accessed 24 Jun 2021

  3. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER Research Data, 9 Registries, Nov 2020 Sub (1975–2018) - Linked To County Attributes - Time Dependent (1990–2018) Income/Rurality, 1969–20

  4. Surveillance Research Program, National Cancer Institute SEER*Stat software (seer.cancer.gov/seerstat) version 8.3.9

  5. Miller KD, Fidler-Benaoudia M, Keegan TH et al (2020) Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin 70:443–459. https://doi.org/10.3322/CAAC.21637

    Article  PubMed  Google Scholar 

  6. About Social Determinants of Health (SDOH). https://www.cdc.gov/socialdeterminants/about.html. Accessed 5 Aug 2021

  7. Wolfson J, Sun CL, Kang T et al (2014) Impact of treatment site in adolescents and young adults with central nervous system tumors. J Natl Cancer Inst. https://doi.org/10.1093/jnci/dju166

    Article  PubMed  PubMed Central  Google Scholar 

  8. Puthenpura V, Canavan ME, Poynter JN et al (2021) Racial/ethnic, socioeconomic, and geographic survival disparities in adolescents and young adults with primary central nervous system tumors. Pediatr Blood Cancer 68:1–11. https://doi.org/10.1002/pbc.28970

    Article  Google Scholar 

  9. Johnson K, Wang X, Barnes J, Delavar A (2021) Associations between geographic residence and US adolescent and young adult cancer stage and survival. Cancer. https://doi.org/10.1002/CNCR.33667

    Article  PubMed  PubMed Central  Google Scholar 

  10. AYA SIte Recode/WHO 2008 Definition. https://seer.cancer.gov/ayarecode/aya-who2008.html. Accessed 30 Aug 2021

  11. Massarweh NN, Chiang Y-J, Xing Y et al (2014) Association between travel distance and metastatic disease at diagnosis among patients with colon cancer. J Clin Oncol 32:942–948. https://doi.org/10.1200/JCO.2013.52.3845

    Article  PubMed  PubMed Central  Google Scholar 

  12. National Cancer Database Participant Use Data File (PUF) Data Dictionary; Version: PUF 2015 – Containing cases diagnosed in 2004–2015. https://www.facs.org/-/media/files/quality-programs/cancer/ncdb/puf_data_dictionary_2015.ashx. Accessed 15 Oct 2020

  13. USDA ERS - Documentation. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/documentation/. Accessed 11 Jan 2021

  14. Qingzhao Y, Bin L (2017) mma: an R package for mediation analysis with multiple mediators. J Open Res Softw 5:11. https://doi.org/10.5334/JORS.160

    Article  Google Scholar 

  15. Lopez Ramos C, Brandel MG, Steinberg JA et al (2019) The impact of traveling distance and hospital volume on post-surgical outcomes for patients with glioblastoma. J Neurooncol 141:159–166. https://doi.org/10.1007/s11060-018-03022-w

    Article  PubMed  Google Scholar 

  16. Aulakh S, Dedeo MR, Free J et al (2021) Survival trends in glioblastoma and association with treating facility volume Sonikpreet. J Clin Neurosci 68:271–274. https://doi.org/10.1016/j.jocn.2019.04.028.Survival

    Article  Google Scholar 

  17. Koshy M, Sher DJ, Spiotto M et al (2017) Association between hospital volume and receipt of treatment and survival in patients with glioblastoma. J Neurooncol 135:529–534

    CAS  Article  Google Scholar 

  18. Knops RRG, van Dalen EC, Mulder RL et al (2013) The volume effect in paediatric oncology: a systematic review. Ann Oncol 24:1749–1753. https://doi.org/10.1093/annonc/mds656

    CAS  Article  PubMed  Google Scholar 

  19. Smith ER, Butler WE, Barker FG et al (2004) Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery 54:553–565. https://doi.org/10.1227/01.NEU.0000108421.69822.67

    Article  PubMed  Google Scholar 

  20. Danjoux CE, Jenkin RDT, Mclaughlin J (1996) Childhood medulloblastorna in Ontario, 1 977–1 987. Popul. Based Res. 9:1–9

    Google Scholar 

  21. Zhu P, Du X, Zhu J, Esquenazi Y (2019) Improved survival of glioblastoma patients treated at academic and high-volume facilities: a hospital-based study from the National Cancer Database. J Neurosurg 132:491–502. https://doi.org/10.3171/2018.10.JNS182247

    Article  PubMed  Google Scholar 

  22. Tchelebi LT, Shen B, Wang M et al (2021) Impact of radiation therapy facility volume on survival in patients with cancer. Cancer. https://doi.org/10.1002/CNCR.33777

    Article  PubMed  Google Scholar 

  23. Stoltzfus KC, Shen B, Tchelebi L et al (2021) Impact of facility surgical volume on survival in patients with cancer. J Natl Compr Cancer Netw 19:495–503. https://doi.org/10.6004/JNCCN.2020.7644

    Article  Google Scholar 

  24. Delavar A, Barnes JM, Wang X, Johnson KJ (2020) Associations between Race/Ethnicity and US Childhood and Adolescent Cancer Survival by Treatment Amenability. JAMA Pediatr. https://doi.org/10.1001/jamapediatrics.2019.6074

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cowan R, Shuk E, Byrne M et al (2019) Factors associated with use of a high-volume cancer center by black women with ovarian cancer. J Oncol Pract 15:E769–E776. https://doi.org/10.1200/JOP.18.00741

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Per the NCDB data use agreement, we acknowledge that The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data. We are grateful to Caitlin O'Connell for editorial and paper submission assistance.

Funding

This work was supported by the Center for Health Economics and Policy Pilot Funding Program at the Institute for Public Health at Washington University (PI: Kimberly Johnson, MPH, Ph.D.).

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Authors and Affiliations

Authors

Contributions

KJJ: Conceptualization, formal analysis, funding acquisition, writing-original draft, and writing-reviewing and editing. XW: formal analysis and writing-reviewing and editing. Justin Barnes: writing-original draft, and writing-reviewing and editing. AD: writing-original draft, and writing-reviewing and editing.

Corresponding author

Correspondence to Kimberly J. Johnson.

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The authors have no conflicts of interest or competing interests to report.

Ethical approval

This study has been determined by the Washington University in St. Louis Institutional Review Board to be non-human subjects research.

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Johnson, K.J., Wang, X., Barnes, J.M. et al. Residential distance from the reporting hospital and survival among adolescents, and young adults diagnosed with CNS tumors. J Neurooncol 155, 353–361 (2021). https://doi.org/10.1007/s11060-021-03885-6

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  • DOI: https://doi.org/10.1007/s11060-021-03885-6

Keywords

  • CNS tumors
  • Adolescents and young adults
  • Travel distance
  • Survival