Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis.

Journal Article (Journal Article)

Pediatric neuroblastoma (NB) patients receive multi-modal therapy and may experience care fragmented among multiple institutions with a significant travel burden, which has been associated with poor outcomes for some adult cancers. We hypothesized that fragmented care for pediatric NB patients is associated with inferior outcomes compared to treatment consolidated at one location. We reviewed paper and electronic records for pediatric NB patients who received ≥1 hematopoietic stem cell transplant (HSCT) at Duke from 1990-2017. Fragmented care was defined by treatment at >1 institution and grouped by 2 institutions vs. 3+ institutions. Distances were calculated using Google Maps. To compare all care groups, we used Fisher's Exact and Kruskal-Wallis tests for demographic and treatment characteristics, Kaplan-Meier for unadjusted overall survival (OS), and Cox proportional hazards for factors associated with OS. Of 127 eligible patients, 102 (80.3%) patients experienced fragmented care, with 17 treated at 3+ facilities. Kaplan-Meier analysis did not associate fragmented care with increased mortality (log-rank p = 0.13). With multivariate analysis, only earlier diagnostic decade and greater distance to HSCT remained significantly associated with worsened OS. In this single institutional study, we found fragmented care did not impact overall survival. Worsened overall survival was associated with increased travel distance for HSCT and further research should aim to improve supportive processes for patients undergoing HSCT for high-risk neuroblastoma.

Full Text

Duke Authors

Cited Authors

  • Tarnasky, AM; Achey, MA; Wachsmuth, LP; Williamson, H; Thomas, SM; Commander, SJ; Leraas, H; Driscoll, T; Tracy, ET

Published Date

  • November 2021

Published In

Volume / Issue

  • 38 / 8

Start / End Page

  • 731 - 744

PubMed ID

  • 33970762

Electronic International Standard Serial Number (EISSN)

  • 1521-0669

International Standard Serial Number (ISSN)

  • 0888-0018

Digital Object Identifier (DOI)

  • 10.1080/08880018.2021.1922557


  • eng