Travel to high-volume centers for esophageal cancer surgery linked to longer survival
Key takeaways:
- Patients who underwent esophagectomy at high-volume centers had improved 1-year and 5-year OS.
- Those with stage III disease derived the most benefit from treatment at high-volume centers.
Patients who traveled to high-volume centers for esophagectomy experienced better outcomes than those who sought treatment locally at low-volume centers, according to results of a cohort study.
Treatment at high-volume centers appeared associated with higher likelihood of 1-year and 5-year survival.
“Such survival benefit appeared to be most significant for patients with locoregionally advanced, stage II through [stage] III adenocarcinoma,” Sara Sakowitz, MS, MPH, health services researcher at UCLA CORELAB and medical student at UCLA’s David Geffen School of Medicine, and colleagues wrote. “With implications toward national policy and practice, as well as the broader centralization of complex oncologic care, several of these findings merit further discussion.”
Efforts have been made to regionalize treatment for esophageal adenocarcinoma at high-volume centers. However, this has added to patients’ travel burden and also contributed to a lack of continuity in postoperative care, according to study background.
Sakowitz and colleagues aimed to determine whether traveling to a high-volume center (HVCs) for esophagectomy is linked with improved outcomes for esophageal adenocarcinoma compared with receiving care locally at low-volume centers (LVCs).
Researchers used the 2010-2021 National Cancer Database to identify 17,920 patients diagnosed with stage I through stage III esophageal adenocarcinoma.
Investigators stratified patients based on distance needed to travel to receive care and the annual esophagectomy volume at the treating location.
The travel-HVC cohort included patients in the top 25th percentile of travel burden who received care at centers in the top volume quartile. The local-LVC cohort included patients in the bottom 25th percentile of travel burden who received treatment at centers in the lowest-volume quartile.
OS at 1 year and 5 years served as the primary endpoint. Perioperative outcomes served as a secondary endpoint.
The final study population included 4,311 patients median interquartile age, 65 years; 87% men). The travel IVC subgroup included 2,342 patients and the local-LVC cohort included 1,969 patients.
Patients who traveled to HVCs had improved 1-year OS (HR = 0.69; 95% CI, 0.58-0.83) and 5-year OS (HR = 0.8; 95% CI, 0.7-0.9) compared with patients who did not travel and received care at LVCs.
After stratifying for disease stage, patients with stage I disease exhibited comparable outcomes regardless of whether they traveled to HVCs or sought treatment locally at LVCs. However, among patients with stage III disease, those who traveled to HVCs appeared more likely than those who sought local care at LVCs to survive 1 year (HR = 0.72; 95% CI, 0.6-0.87) and 5 years (HR = 0.83; 95% CI, 0.74-0.93).
Travel to HVCs also appeared linked to greater lymph node harvest (beta = 5.08 nodes; 95% CI, 3.78-6.37) and greater likelihood of margin-negative resection (adjusted OR = 1.83; 95% CI, 1.29-2.6).
Researchers acknowledged study limitations, including a lack of assessment of timing in disease onset or severity at presentation; a lack of details about patient frailty, smoking status or functional status; and lack of evaluation of individuals deemed to not be surgical candidates.
“Future studies are needed to ascertain barriers to treatment and develop novel targeted pathways to ensure equitable access to high-volume facilities and high-quality oncologic care,” Sakowitz and colleagues wrote.
Collapse