Abstract
PurposeThe survival impact of geographic access to specialized care remains unknown in patients with soft-tissue sarcomas (STS). This study aimed to clarify the association between the patient travel distance and survival outcome and investigate the factors lying behind it.MethodsA total of 34 528 patients with STS registered in the National Cancer Data Base, diagnosed from 2004–2016, were investigated.ResultsTumor stage correlated with travel distance: patients with metastatic disease stayed closer to home. However, the type of facility showed greatest variation: 37.0%, 51.0%, 73.5%, and 75.9% of patients with ≤10 miles, 10.1–50 miles, 50.1–100 miles, and >100 miles, respectively (P<0.001), had a sarcoma care at academic/research centers. On a multivariable analysis, reduced mortality risk was associated with longer (versus short) travel distance (>100 miles: HR = 0.877; P = 0.001) and management at academic/research (versus non-academic/research) centers (HR = 0.857; P<0.001). The greatest divergence was seen in patients traveling very long distance (>100 miles) to an academic/research center, with a 26.9% survival benefit (HR = 0.731; P<0.001), compared with those traveling short distance (≤10 miles; 95.4% living in metropolitan area) to a non-academic/research center. There was no significant correlation between travel distance and survival in patients who had care at academic/research centers, whereas a survival benefit of management at academic/research centers was observed in every group of travel distance, regardless of tumor stage.ConclusionsThis national study demonstrated that increased travel distance was associated with superior survival, attributable to a higher proportion of patients receiving sarcoma care at distant academic/research centers. These data support centralized care for STS. Overcoming referral and travel barriers may enable more patients to be treated at specialized centers and may further improve survival rates for patients with STS, even when it imposes an increased travel burden.
Highlights
Soft-tissue sarcomas (STS) are a heterogeneous group of rare cancers
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This national study demonstrated that increased travel distance was associated with superior survival, attributable to a higher proportion of patients receiving sarcoma care at distant academic/research centers
Overcoming referral and travel barriers may enable more patients to be treated at specialized centers and may further improve survival rates for patients with STS, even when it imposes an increased travel burden
Summary
Soft-tissue sarcomas (STS) are a heterogeneous group of rare cancers (incidence of 4–5 cases per 100 000 individuals, < 1% of all malignant tumors [1,2]). Prior European studies have demonstrated that sarcoma care at a specialized sarcoma center is associated with decreased risk of tumor relapse and better survival [7]. In those medical systems patients who reside far from sarcoma institutes are required to travel long distances to receive the most effective sarcoma care. The influence of travel distance on sarcoma stage at presentation or patient survival remains to be elucidated in the US system
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