Distance to cancer center may impact survival of AYAs with central nervous system tumors
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Adolescent and young adult patients with central nervous system tumors who lived farther from the reporting hospital had a lower risk for death than those who lived closer, according to study results published in Journal of Neuro-Oncology.
The reason, researchers wrote, could be that patients traveling from farther away receive treatment at higher-volume facilities with more experience treating CNS tumors. Moreover, not all patient groups benefited equally, according to Kimberly J. Johnson, MD, PhD, associate professor and cancer epidemiologist at Brown School at Washington University in St. Louis.
“We found a greater survival benefit in association with distance to the reporting hospital for patients with low-grade astrocytic tumors and ependymomas than other tumors, non-Hispanic white individuals vs. non-Hispanic Black and Hispanic individuals, and those with residences at diagnosis or initial treatment in higher-income areas,” Johnson told Healio. “This seems to indicate that people with more resources may be able to travel farther to facilities with more expertise. This, in turn, may impact survival outcomes.”
Johnson and colleagues pursued the research because they found an association of living from the reporting hospital with improved survival among patients with CNS tumors in contrast to shorter survival for other tumor types. and they wanted to explore the association in more depth.
Researchers gathered data from the National Cancer Database on adolescents and young adults (AYAs) aged 15 to 39 years diagnosed with cancer from 2010 to 2014. The survival analysis included 9,335 AYAs (56.1% male; 72.7% non-Hispanic white; 49.2% aged 30-39 years) diagnosed with CNS and other intracranial and intraspinal neoplasms.
Johnson and colleagues classified the patients into three categories, depending on the distance between the patient’s place of residence and where they received either their diagnosis or first treatment: short ( 12.5 miles; n = 4,007), intermediate (> 12.5 and < 50 miles; n = 3,215), and long ( 50 miles; n = 2,113). They used Cox proportional hazard regression models for analyses.
After adjustment for age, sex, race/ethnicity and ZIP code-level education and income, results showed AYAs with CNS tumors who lived farther from the reporting hospital had a reduced risk for death than those who lived shorter distances (intermediate vs. short distance, HR = 1.06; 95% CI, 0.96-1.17; long vs. short distance, HR = 0.82; 95% CI 0.73-0.93). The association of long vs. short distance attenuated after researchers adjusted for facility volume of patients with CNS tumors (HR = 0.92; 95% CI, 0.81-1.04).
“Why CNS tumors are somewhat different from other tumor types is a little surprising, but perhaps it is due to the very specialized neuro-oncology expertise needed to successfully treat these tumors,” Johnson said. “I found it notable that the survival benefit associated with longer distances only applied to non-Hispanic white patients.”
Johnson and colleagues reported a significant association between distance from the reporting facility and survival based on race/ethnicity (P = .0002) and income (P = .02).
In two models — one adjusted for age, sex, education and income quartile and another adjusted for facility CNS tumor volume — they observed lower HRs for long vs. short residential distance to reporting facility among non-Hispanic white AYAs (model 1, HR = 0.76; 95% CI, 0.66-0.87; model 2, HR = 0.86; 95% CI, 0.74-1) than among non-Hispanic Black AYAs (model 1, HR = 0.94; 95% CI, 0.67-1.31; model 2, HR = 0.99; 95% CI, 0.7-1.4). Additionally, AYAs living in areas with the highest median ZIP code-level income had the lowest HR in association with long vs. short residential distance to reporting hospital in both models (model 1, HR = 0.71; 95% CI, 0.53-0.94; model 2, HR = 0.8; 95% CI, 0.59-1.09).
“More research is needed to understand the barriers to access in these patients to develop strategies that address these disparities,” Johnson said. “Barriers may be related to direct and indirect costs associated with care, such as living and traveling expenses, time off work, and not being able to care for family members.”
Johnson and colleagues are continuing the research to examine how the characteristics of facilities may be impacting outcomes in patients with CNS tumors.
For more information:
Kimberly J. Johnson, MD, PhD, can be reached at Brown School, Washington University in St. Louis, Campus Box 1196, 1 Brookings Drive, St. Louis, MO 63130; email: kijohnson@wustl.edu.
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