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



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.


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.


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.


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


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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.


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



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.

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Correspondence to Kimberly J. Johnson.

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

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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).

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