Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.

<h4>Purpose</h4>The 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.<h...

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Autores principales:	Tomohiro Fujiwara, Koichi Ogura, John Healey
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3db87b3eaa9542afb04bcfcfc3769bbe
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spelling	oai:doaj.org-article:3db87b3eaa9542afb04bcfcfc3769bbe2021-11-25T06:23:36ZGreater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.1932-620310.1371/journal.pone.0252381https://doaj.org/article/3db87b3eaa9542afb04bcfcfc3769bbe2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252381https://doaj.org/toc/1932-6203<h4>Purpose</h4>The 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.<h4>Methods</h4>A total of 34 528 patients with STS registered in the National Cancer Data Base, diagnosed from 2004-2016, were investigated.<h4>Results</h4>Tumor 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.<h4>Conclusions</h4>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. 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.Tomohiro FujiwaraKoichi OguraJohn HealeyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252381 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Tomohiro Fujiwara Koichi Ogura John Healey Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.
description	<h4>Purpose</h4>The 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.<h4>Methods</h4>A total of 34 528 patients with STS registered in the National Cancer Data Base, diagnosed from 2004-2016, were investigated.<h4>Results</h4>Tumor 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.<h4>Conclusions</h4>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. 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.
format	article
author	Tomohiro Fujiwara Koichi Ogura John Healey
author_facet	Tomohiro Fujiwara Koichi Ogura John Healey
author_sort	Tomohiro Fujiwara
title	Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.
title_short	Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.
title_full	Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.
title_fullStr	Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.
title_full_unstemmed	Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.
title_sort	greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: us nationwide patterns.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/3db87b3eaa9542afb04bcfcfc3769bbe
work_keys_str_mv	AT tomohirofujiwara greatertraveldistancetospecializedfacilitiesisassociatedwithhighersurvivalforpatientswithsofttissuesarcomausnationwidepatterns AT koichiogura greatertraveldistancetospecializedfacilitiesisassociatedwithhighersurvivalforpatientswithsofttissuesarcomausnationwidepatterns AT johnhealey greatertraveldistancetospecializedfacilitiesisassociatedwithhighersurvivalforpatientswithsofttissuesarcomausnationwidepatterns
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Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns.

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