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The Effects of Travel Burden on Outcomes After Resection of Extrahepatic Biliary Malignancies: Results from the US Extrahepatic Biliary Consortium

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Surgical resection of extrahepatic biliary malignancies has been increasingly centralized at high-volume tertiary care centers. While this has improved outcomes overall, increased travel burden has been associated with worse survival for many other malignancies. We hypothesized that longer travel distances are associated with worse outcomes for these patients as well.

Study Design

Data was analyzed from the US Extrahepatic Biliary Consortium database, which retrospectively reviewed patients who received resection of extrahepatic biliary malignancies at 10 high-volume centers. Driving distance to the patient’s treatment center was measured for 1025 patients. These were divided into four quartiles for analysis: < 24.5, 24.5–57.2, 57.2–117, and < 117 mi. Cox proportional hazard models were then used to measure differences in overall survival.

Results

No difference was found between the groups in severity of disease or post-operative complications. The median overall survival in each quartile was as follows: 1st = 1.91, 2nd = 1.60, 3rd = 1.30, and 4th = 1.39 years. Patients in the 3rd and 4th quartile had a significantly lower median household income (p = 0.0001) and a greater proportion Caucasian race (p = 0.0001). However, neither of these was independently associated with overall survival. The two furthest quartiles were found to have decreased overall survival (HR = 1.39, CI = 1.12–1.73 and HR = 1.3, CI = 1.04–1.62), with quartile 3 remaining significant after multivariate analysis (HR = 1.45, CI = 1.04–2.0, p = 0.028).

Conclusions

Longer travel distances were associated with decreased overall survival, especially in the 3rd quartile of our study. Patients traveling longer distances also had a lower household income, suggesting that these patients have significant barriers to care.

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References

  1. Fong Y, Gonen M, Rubin D, Radzyner M, Brennan M; Long-Term Survival is Superior after Resection for Cancer in High- Volume centers. Ann Surg 2005;242:540–547

    PubMed  PubMed Central  Google Scholar 

  2. Lidsky ME, Zhifei S, Nussbaum DP, Adam MA, Speicher PJ, Blazer DG; Going the extra mile Improved survival for Pancreatic cancer patients traveling to High-Volume Centers. Ann Surg. 2016; 20(10): 1–6

    Google Scholar 

  3. Aquina CT, Probst CP, Becerra AZ, Lannuzzi JC, Kelly KN, Hensley, BJ, Rickles AS, Noyes K, Fleming JF, Monson JR. High volume improved outcomes: The argument for centralization of rectal cancer surgery. Surgery 2016; 159(3): 736–48

    Article  PubMed  Google Scholar 

  4. Stitzenberg KB, Sigurdson ER, Egleston BL, et al: Centralization of cancer surgery: implications for patient access to optimal care. J Clin Oncol 2009;27:4671–4678

    Article  PubMed  PubMed Central  Google Scholar 

  5. Etzioni DA, Fowl RJ, Wasif N, Donohue JH, Cima RR; Distance Bias and Surgical Outcomes. Medical Care 2013; 51(3):238–244

    Article  PubMed  Google Scholar 

  6. Paltiel O, Ronen I, Polliack A, Epstein L. Two-way referral bias: evidence from a clinical audit of lymphoma in a teaching hospital. J Clin EpidemioI. 1998; 51:93–98

    Article  CAS  Google Scholar 

  7. Wasif N, Chang YH, Pockag BA, Gray RJ, Mathur A, Etzioni D; Association of Distance traveled for surgery with short and long- term Cancer Outcomes. Ann Surg Oncol 23:3444–3452 2016

    Article  PubMed  Google Scholar 

  8. Lamond EB, Hayreh D, Picket KE, Dignam JJ, List MA, Stenson KM, Haraf DJ, Brockstein BE, Sellergreen SA, Vokes EE; Is patient travel distance associated with survival on phase II clinical trials in oncology?. J Natl Cancer Inst. 2003; 95(18):1370–1375

    Article  Google Scholar 

  9. Rodriguez CP, Jawde RA, Rybicki LA, Kalaycio ME, Advani A, Sobecks R, Sekeres MA. Impact of Socioeconomic status and Distance from treatment center on the survival in patients receiving remission induction therapy for newly diagnosed acute myeloid leukemia. Leuk Res. 2008; 32(3):413–20

    Article  PubMed  Google Scholar 

  10. Stitzenberg KB, Chang Y, Smith AB, Neilsen ME; Exploring the burden of Inpatient Readmissions after Major Cancer Surgery. J Clin Onco 2014;33:455–464

    Article  Google Scholar 

  11. Kneuertz PJ, Kao LS, Ko TC, Wray CJ; Regional disparities affected treatment and survival of patient with intrahepatic cholangiocarcinoma—a Texas Cancer Registry analysis. J Surg Oncol. 2014: 110(4):416–421

    Article  PubMed  Google Scholar 

  12. Goetze, TO, Paolucci V. Influence of High- and Low-volume liver surgery in gallbladder carcinoma. World J Gastroenterol. 2014; 20(48):18445–51

    Article  PubMed  PubMed Central  Google Scholar 

  13. Proctor BD, Semega JL, Kollar MA. Income and poverty in the United States:2015. U.S. Census Bureau, Current Population Reports. 2016; 1–25

  14. Speicher PJ, Englum BR, Canapathi AM, Xiaofei W, Gartwig MC, D’Amico TA, Berry MF; Traveling to a High-Volume Center is associated with Improved Survival for Patients with Esophageal cancer. Ann Surg 256:743–749 2016;

    Google Scholar 

  15. Ambroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L. Distance as a Barrier to cancer diagnosis and treatment: Review of the Literature. Oncologist. 2015. 20(2):1378–85

    Article  PubMed  PubMed Central  Google Scholar 

  16. Scoggins JF, Fedorenko CR, Donahue SM, Buchwald D, Blough DK, Ramsey SD. Is Distance to Provider a barrier to care for medicated patients with breast, colorectal, or lung cancer. J Rural Health. 2012. 28(1): 54–62

    Article  PubMed  Google Scholar 

  17. Sharrocks K, Spicer J, Camidge DR, Papa S. The impact of socioeconomic status on access to cancer clinical trials. British Journal of Cancer. 2015. 111:1684–87

    Article  Google Scholar 

  18. Smith AK, Shara NM, Zeymo A, Harris K, Estes R, Johnson LB, Al-Refaie WB; Travel patterns of cancer surgery patients in a regionalized system. J Surg Res 199:97–105 2015

    Article  PubMed  Google Scholar 

  19. Eli K, Vourlekis B, Xie B, Nedjat-Haiem FR, Lee PJ, Murderspach L, Russel C, Palinkas LA. Cancer treatment adherance among low-income women with breast or gynecologica cancer: a randomized controlled trial of patient navigation. Cancer. 2009. 115(19): 4606–15

    Article  Google Scholar 

  20. Ko NY, Darnell JS, Calhoun E, Freund KM, Wells KJ, Shapiro CL, Dudley DJ, Patierno SR, Fiscella K, Raish P, Battaglia TA. J Clin Oncol. 2014. 32(25): 2758–64

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA

    Sean C. O’Connor & Gregory Russell

  2. Medical College of Wisconsin, Milwaukee, WI, USA

    Harveshp Mogal

  3. Emory University Medical Center, Atlanta, GA, USA

    Cecilia Ethun & Shishir Maithel

  4. Washington University, St. Louis, MO, USA

    Ryan C. Fields & Linda Jin

  5. New York University, New York, NY, USA

    Ioannis Hatzaras & Gerardo Vitiello

  6. Vanderbilt University, Nashville, TN, USA

    Kamran Idrees & Chelsea A. Isom

  7. University of Louisville, Louisville, KY, USA

    Robert Martin & Charles Scoggins

  8. Ohio State University, Columbus, OH, USA

    Timothy M. Pawlik & Carl Schmidt

  9. Stanford University, Palo Alto, CA, USA

    George Poultsides & Thuy B. Tran

  10. University of Wisconsin, Madison, WI, USA

    Sharon Weber & Ahmed Salem

  11. Department of Surgery, Division of Surgical Oncology, Wake Forest University, Medical Center Blvd, Winston-Salem, NC, 27157, USA

    Perry Shen

Authors
  1. Sean C. O’Connor
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  2. Harveshp Mogal
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  3. Gregory Russell
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  4. Cecilia Ethun
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  5. Ryan C. Fields
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  6. Linda Jin
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  7. Ioannis Hatzaras
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  8. Gerardo Vitiello
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  9. Kamran Idrees
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  10. Chelsea A. Isom
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  11. Robert Martin
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  12. Charles Scoggins
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  13. Timothy M. Pawlik
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  14. Carl Schmidt
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  15. George Poultsides
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  16. Thuy B. Tran
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  17. Sharon Weber
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  18. Ahmed Salem
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  19. Shishir Maithel
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  20. Perry Shen
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Contributions

Study conception and design, drafting of manuscript, acquisition of data, critical revision: O’Connor, Mogal, Shen. Acquisition of data, interpretation of data, revision of manuscript, final approval of manuscript: Ethun, Fields, Jin, Hatzaras, Shenoy, Idrees, Isom, Martin, Scoggins, Pawlik, Schmidt, Poultsides, Tran, Weber, Salem, Maithel, Russell

Corresponding author

Correspondence to Perry Shen.

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Ethics Statement

Institutional Review Board approval was obtained for the study.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Additional information

Supported by: Wake Forest University Biostatistics shared resource NCI CCSG P30CA012197.

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O’Connor, S.C., Mogal, H., Russell, G. et al. The Effects of Travel Burden on Outcomes After Resection of Extrahepatic Biliary Malignancies: Results from the US Extrahepatic Biliary Consortium. J Gastrointest Surg 21, 2016–2024 (2017). https://doi.org/10.1007/s11605-017-3537-4

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  • DOI: https://doi.org/10.1007/s11605-017-3537-4

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