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UPJ INSIGHT Distance to Treatment With Radical Cystectomy in a Rural State: Long Car Rides, Equivalent Outcomes

By: Randie E. White, MD, Maine Medical Center, Portland; Joshua A. Linscott, MD, PhD, Moffit Cancer Center, Tampa, Florida; Matthew T. Hayn, MD, Maine Medical Center, Portland; Stephen T. Ryan, MD, Maine Medical Center, Portland; Jeffrey M. Howard, MD, PhD, Maine Medical Center, Portland; Evelyn James, BA, MPH, Maine Medical Center, Portland; Moritz H. Hansen, MD, Maine Medical Center, Portland; Jesse D. Sammon, DO, Maine Medical Center, Portland | Posted on: 15 Dec 2023

White RE, Linscott JA, Hayn MT, et al. Distance to treatment with radical cystectomy in a rural state: long car rides, equivalent outcomes. Urol Pract. 2023;10(6):588-594.

Study Need and Importance

Radical cystectomy (RC) is a complex surgery with better outcomes reported when performed at high-volume centers. This requires some patients to travel far distances for care. Additionally, RC is a surgery with high morbidity and frequent readmissions. Therefore, evaluation of the impact of travel distance on receipt of treatment and patient outcomes is warranted.

What We Found

Between 2015 and 2021, 220 patients underwent RC for bladder cancer: 38.6% were readmitted; of these 62.5% were readmitted or transferred to the initial treatment center. All patients readmitted and cared for at an outside hospital traveled ≥ 12.5 miles. Rate of complications and survival was equivalent across travel distance groups. High-grade complications most often required treatment at the index center, while low-grade complications were more often treated at an outside hospital (Figure). While there was no difference in time to initiation of neoadjuvant chemotherapy or time to consolidative surgery by distance traveled, time to surgery without neoadjuvant chemotherapy (upfront RC) was significantly increased for patients traveling traveled ≥ 12.5 miles.

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Figure. Heat map of regionalization of radical cystectomy care in Maine. A, Centroid zip code of patient home address. B, Location of readmission hospital. C, Location of readmission hospital, including critical access hospitals for low-grade complications. D, Readmission to higher acuity treatment facilities through the state for high-grade complications.

Limitations

This is a single-institution, retrospective study with a population of mostly non-Hispanic White patients and may not be generalizable to other groups.

Interpretation for Patient Care

While patients with muscle-invasive bladder cancer may travel farther distances for care, this does not impact treatment outcomes. We attribute this result to a robust network of coordination of care with nurse navigators, referral networks, and a statewide electronic medical record. Travel distance is most pertinent in impacting access to care, such as increase in time to consolidative surgery, and in the postoperative period, where travel distance affects readmission to the treatment center based on complication grade.

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