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Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer.

Publication ,  Journal Article
Speicher, PJ; Englum, BR; Ganapathi, AM; Wang, X; Hartwig, MG; D'Amico, TA; Berry, MF
Published in: Ann Surg
March 15, 2016

BACKGROUND: An association between volume and outcomes has been observed for esophagectomy, though little is known about why or how patients choose low- or high-volume centers. The purpose of this study was to evaluate how travel burden and hospital volume influence treatment and outcomes of patients with locally advanced esophageal cancer. METHODS: Predictors of receiving esophagectomy for patients with T1-3N1M0 mid or distal esophageal cancer in the National Cancer Data Base from 2006 to 2011 were identified using multivariable logistic regression. Survival was compared using propensity score-matched groups: patients in the bottom quartile of travel distance who underwent treatment at low-volume facilities (Local) and patients in the top quartile of travel distance who underwent treatment at high-volume facilities (Travel). RESULTS: Of 4979 patients who met inclusion criteria, we identified 867 Local patients who traveled 2.7 [interquartile range (IQR): 1.6-4 miles] miles to centers that treated 2.6 (IQR: 1.9-3.3) esophageal cancers per year, and 317 Travel patients who traveled 107.1 (IQR: 65-247) miles to centers treating 31.9 (IQR: 30.9-38.5) cases. Travel patients were more likely to undergo esophagectomy (67.8% vs 42.9%, P < 0.001) and had significantly better 5-year survival (39.8% vs 20.6%, P < 0.001) than Local patients. CONCLUSIONS: Patients who travel longer distances to high-volume centers have significantly different treatment and better outcomes than patients who stay close to home at low-volume centers. Strategies that support patient travel for treatment at high-volume centers may improve esophageal cancer outcomes.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

March 15, 2016

Location

United States

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
 

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Speicher, P. J., Englum, B. R., Ganapathi, A. M., Wang, X., Hartwig, M. G., D’Amico, T. A., & Berry, M. F. (2016). Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer. Ann Surg. https://doi.org/10.1097/SLA.0000000000001702
Speicher, Paul J., Brian R. Englum, Asvin M. Ganapathi, Xiaofei Wang, Matthew G. Hartwig, Thomas A. D’Amico, and Mark F. Berry. “Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer.Ann Surg, March 15, 2016. https://doi.org/10.1097/SLA.0000000000001702.
Speicher PJ, Englum BR, Ganapathi AM, Wang X, Hartwig MG, D’Amico TA, et al. Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer. Ann Surg. 2016 Mar 15;
Speicher, Paul J., et al. “Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer.Ann Surg, Mar. 2016. Pubmed, doi:10.1097/SLA.0000000000001702.
Speicher PJ, Englum BR, Ganapathi AM, Wang X, Hartwig MG, D’Amico TA, Berry MF. Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer. Ann Surg. 2016 Mar 15;

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

March 15, 2016

Location

United States

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences