PD32-03 PATIENTS TRAVEL FURTHER FOR BLADDER CANCER CARE: A CRITICAL ANALYSIS OF CENTRALIZATION

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III (PD32)1 Apr 2020PD32-03 PATIENTS TRAVEL FURTHER FOR BLADDER CANCER CARE: A CRITICAL ANALYSIS OF CENTRALIZATION Kelly Pekala*, Jonathan Yabes, Jathin Bandari, Michelle Yu, Anup Shah, Benjamin Davies, Lindsay Sabik, Jeremy Kahn, and Bruce Jacobs Kelly Pekala*Kelly Pekala* More articles by this author , Jonathan YabesJonathan Yabes More articles by this author , Jathin BandariJathin Bandari More articles by this author , Michelle YuMichelle Yu More articles by this author , Anup ShahAnup Shah More articles by this author , Benjamin DaviesBenjamin Davies More articles by this author , Lindsay SabikLindsay Sabik More articles by this author , Jeremy KahnJeremy Kahn More articles by this author , and Bruce JacobsBruce Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000896.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High-volume centers are associated with improved outcomes across both surgical and nonsurgical care. The extent to which this has led to centralized care for bladder cancer patients is unknown. We sought to examine trends in centralization among surgical and nonsurgical care and its associations with increased travel distances for bladder cancer patients. METHODS: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified all patients diagnosed with at least muscle-invasive bladder cancer between 2004-2013. To assess centralization, we examined the proportion of patients treated at a high-volume center (i.e., top quintile) over time. This calculation was performed for both surgical (cystectomy) and nonsurgical (radiation, chemotherapy) care. We also assessed patient travel distances for each treatment over this time period by calculating the straight-line distance from the patient’s ZIP code to the treating hospital’s ZIP code. Multilevel linear probability models with hospital-level random effects and median regression were used to examine trends in proportion treated in high volume centers and patient travel distance, respectively. RESULTS: We identified all patients who underwent radical cystectomy (n=6,756), radiation (n=5,832), and chemotherapy (n=7,730). Cystectomy became more centralized over time, with 50.8% of patients undergoing surgery in a high-volume center in 2004 versus 68.8% in 2013 (p<0.05). This pattern was less pronounced for radiation and chemotherapy (both p>0.05). For all 3 treatments, the median distance travelled increased significantly over time (all p<0.05) (Figure 1). Median travel distances increased by 12.42, 1.06, and 2.89 miles for cystectomy, radiation, and chemotherapy, between 2004 and 2013 respectively, despite stable proportions of patients living in rural areas over this time period. CONCLUSIONS: The increasing centralization of bladder cancer care in terms of percent treated at high volume centers has been striking for surgery and less so for radiation and chemotherapy. However, increasing travel distances for all patients suggests that some form of centralization is likely occurring for nonsurgical care. Source of Funding: Supported in part by P30CA047904 from the National Cancer Institute, the Henry L. Hillman Foundation, and the Shadyside Hospital Foundation. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e637-e637 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelly Pekala* More articles by this author Jonathan Yabes More articles by this author Jathin Bandari More articles by this author Michelle Yu More articles by this author Anup Shah More articles by this author Benjamin Davies More articles by this author Lindsay Sabik More articles by this author Jeremy Kahn More articles by this author Bruce Jacobs More articles by this author Expand All Advertisement PDF downloadLoading ...