Greater travel burden for bone sarcoma care may yield higher survival rates
Published results showed patients with bone sarcomas who traveled more miles for treatment had a higher likelihood of receiving high-quality care at a high-volume facility and a lower risk of mortality.
“In adult patients, survival outcomes in patients who traveled short distances to low-volume facilities were worse than those in patients who traveled long distances to high-volume facilities, indicating the advantages of pursuing care at specialized institutions despite the possible travel burden,” the authors wrote. “It is crucial that referring providers consider these findings when making recommendations about where to obtain sarcoma care.”
Using the National Cancer Database, researchers examined associations between travel distance and survival among 8,432 patients with bone sarcomas diagnosed from 2004 to 2015. Researchers used multivariable Cox regression analyses that controlled for sociodemographic, clinical and hospital-level factors to identify associations, while subgroup analyses stratified patients by histological diagnosis, tumor stage and pediatric or adult status.
Results showed patients who traveled 50 miles or greater had a lower mortality risk vs. patients who traveled 10 miles or less. Researchers found patients at high-volume facilities had a lower mortality risk compared with patients at low-volume facilities.
Researchers noted 53% of patients who traveled 50 miles or more received care at a high-volume facility. This was compared with 32% of patients who traveled 11 to 49 miles and 18% of patients who traveled 10 miles or less, according to results. Researchers found patients had a lower risk of mortality if they traveled 50 miles or more to a high-volume facility vs. patients who traveled 10 miles or less to a low-volume facility. Patients with osteosarcoma, Ewing sarcoma and chondrosarcoma; patients with stage I, II and IV tumors; and adults had worse overall survival if they traveled a short distance to a low-volume facility, according to subgroup analyses.
Perspective
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Tomohiro Fujiwara, MD, PhD, and colleagues’ findings support our understanding that travel to sarcoma experts is justified, adding that a greater travel burden is associated with better survival. Another recent work similarly observed that treatment of soft tissue sarcoma at a high-volume center mitigates the negative impact of socioeconomic factors on overall survival. However, providers also know well the practical challenges of caring for patients residing remotely. Preliminary data presented at the Connective Tissue Oncology Society’s Annual Meeting suggest that geographically remote patients are, not surprisingly, strained by greater costs of travel and a longer time to diagnosis while also traveling from communities of greater deprivation. The rapid adoption of telehealth during the COVID-19 pandemic demonstrated its utility in providing expert care across a wide geographic region. Yet, as interstate waivers for licensure expire, institutional investment in telehealth will be necessary for its continued use. Elizabeth Heath and colleagues also observed that pre-pandemic total internal relative value units generation may be less when patients travel from more rural areas. Could virtual coordination of care — including concentration of high-quality diagnostics and interventions during rationed travel to the center — help garner institutional buy-in to a care delivery model that improves outcomes by alleviating practical barriers to expert care?
References:
Eastman BM, et al. BMC Cancer. 2021;doi:10.1186/s12885-021-08352-z.
Heath E, et al. Poster 218. Presented at: Connective Tissue Oncology Society Annual Meeting; Nov. 10-13, 2021 (virtual).
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