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

Publication ,  Journal Article
Tarnasky, AM; Achey, MA; Wachsmuth, LP; Williamson, H; Thomas, SM; Commander, SJ; Leraas, H; Driscoll, T; Tracy, ET
Published in: Pediatr Hematol Oncol
November 2021

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.

Duke Scholars

Published In

Pediatr Hematol Oncol

DOI

EISSN

1521-0669

Publication Date

November 2021

Volume

38

Issue

8

Start / End Page

731 / 744

Location

England

Related Subject Headings

  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neuroblastoma
  • Kaplan-Meier Estimate
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Continuity of Patient Care
  • Child
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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MLA
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Tarnasky, A. M., Achey, M. A., Wachsmuth, L. P., Williamson, H., Thomas, S. M., Commander, S. J., … Tracy, E. T. (2021). Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis. Pediatr Hematol Oncol, 38(8), 731–744. https://doi.org/10.1080/08880018.2021.1922557
Tarnasky, Aaron M., Meredith A. Achey, Luke P. Wachsmuth, Hannah Williamson, Samantha M. Thomas, Sarah Jane Commander, Harold Leraas, Tim Driscoll, and Elisabeth T. Tracy. “Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis.Pediatr Hematol Oncol 38, no. 8 (November 2021): 731–44. https://doi.org/10.1080/08880018.2021.1922557.
Tarnasky AM, Achey MA, Wachsmuth LP, Williamson H, Thomas SM, Commander SJ, et al. Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis. Pediatr Hematol Oncol. 2021 Nov;38(8):731–44.
Tarnasky, Aaron M., et al. “Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis.Pediatr Hematol Oncol, vol. 38, no. 8, Nov. 2021, pp. 731–44. Pubmed, doi:10.1080/08880018.2021.1922557.
Tarnasky AM, Achey MA, Wachsmuth LP, Williamson H, Thomas SM, Commander SJ, Leraas H, Driscoll T, Tracy ET. Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis. Pediatr Hematol Oncol. 2021 Nov;38(8):731–744.

Published In

Pediatr Hematol Oncol

DOI

EISSN

1521-0669

Publication Date

November 2021

Volume

38

Issue

8

Start / End Page

731 / 744

Location

England

Related Subject Headings

  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neuroblastoma
  • Kaplan-Meier Estimate
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Continuity of Patient Care
  • Child
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology