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Logan CD, Nunnally SEA, Valukas C, Warwar S, Swinarska JT, Lee FT, Bentrem DJ, Odell DD, Elaraj DM, Sturgeon C. Association between travel distance and overall survival among patients with adrenocortical carcinoma. J Surg Oncol 2023; 128:749-763. [PMID: 37403612 PMCID: PMC10997292 DOI: 10.1002/jso.27387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Regionalization of care is associated with improved perioperative outcomes after adrenalectomy. However, the relationship between travel distance and treatment of adrenocortical carcinoma (ACC) is unknown. We investigated the association between travel distance, treatment, and overall survival (OS) among patients with ACC. METHODS Patients diagnosed with ACC between 2004 and 2017 were identified with the National Cancer Database. Long distance was defined as the highest quintile of travel (≥42.2 miles). The likelihood of surgical management and adjuvant chemotherapy (AC) were determined. The association between travel distance, treatment, and OS was evaluated. RESULTS Of 3492 patients with ACC included, 2337 (66.9%) received surgery. Rural residents were more likely to travel long distances for surgery than metropolitan residents (65.8% vs. 15.5%, p < 0.001), and surgery was associated with improved OS (HR 0.43, 95% CI 0.34-0.54). Overall, 807 (23.1%) patients received AC with rates decreasing approximately 1% per 4-mile travel distance increase. Also, long distance travel was associated with worse OS among surgically treated patients (HR 1.21, 95% CI 1.05-1.40). CONCLUSIONS Surgery was associated with improved overall survival for patients with ACC. However, increased travel distance was associated with lower likelihood to receive adjuvant chemotherapy and decreased overall survival.
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Affiliation(s)
- Charles D. Logan
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Sara E. A. Nunnally
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Catherine Valukas
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Samantha Warwar
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Joanna T. Swinarska
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Frances T. Lee
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David J. Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David D. Odell
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Dina M. Elaraj
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Cord Sturgeon
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
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