Clinical Epidemiology (Aug 2019)
Longer distance to specialized treatment centers does not adversely affect treatment intensity or outcomes in adult acute myeloid leukemia patients. A Danish national population-based cohort study
Abstract
Michael Tøstesen,1 Mette Nørgaard,2 Jan Maxwell Nørgaard,3 Bruno C Medeiros,4 Claus Werenberg Marcher,5 Ulrik Malthe Overgaard,6 Marianne Tang Severinsen,7 Claudia Schoellkopf,8 Lene Sofie Granfeldt Østgård1–31Department of Clinical Medicine, Holstebro Regional Hospital, Aarhus, Denmark; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 3Department of Hematology, Aarhus University Hospital, Aarhus, Denmark; 4Department of Hematology, Stanford University, School of Medicine, Stanford, CA, USA; 5Department of Hematology, Odense University Hospital, Odense, Denmark; 6Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark; 7Department of Hematology, Aalborg University Hospital, Aalborg, Denmark; 8Department of Hematology, Herlev University Hospital, Herlev, DenmarkCorrespondence: Lene Sofie Granfeldt ØstgårdDepartment of Hematology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, DenmarkTel +45 2 972 8127Email [email protected]: Treatment of acute myeloid leukemia (AML) is widely centralized. Longer distances to a specialized treatment center may affect patients’ access to curative-intended treatment. Especially during outpatient treatment, distance may also affect survival.Methods and patients: The authors conducted a national population-based cohort study including all AML patients diagnosed in Denmark between 2000 and 2014. We investigated effects of distance (<10 kilometers [km; reference], 10–25, 25–50, 50–100, >100) to the nearest specialized treatment facility on the probability of receiving intensive chemotherapy, HSCT, and achieving a complete remission (CR) using logistic regression analysis (odds ratios; ORs). For overall survival, we used Cox proportional hazards regression (hazard ratios [HRs]) and adjusted (a) for relevant baseline characteristics.Results: Of 2,992 patients (median age=68.5 years), 53% received intensive chemotherapy and 12% received low-dose chemotherapy outpatient regimens. The median distance to a specialized treatment center was 40 km (interquartile range=10–77 km). No impact of distance to specialized treatment centers was seen on the probability of receiving intensive chemotherapy (10–25 km, aOR=1.1 (CI=0.7–1.7), 25–50 km, aOR=1.1 (CI=0.7–1.7), 50–100 km, aOR=1.3 (CI=0.9–1.9), and >100 km, aOR=1.4 [CI=0.9–2.2]). Overall survival in patients regardless of therapy (<10 km, aOR=1.0 vs >100 km, aOR=1.0 [CI=0.9–1.2]), in intensive therapy patients, or in patients’ choice of post-remission was not affected by distance to specialized treatment center. Distance to a transplant center also did not affect the probability of HSCT or survival post-HSCT.Conclusion: In Denmark, distance to a specialized treatment facility offering remission-induction chemotherapy and HSCT does not negatively affect access to curative-indented therapy, treatment-response, or survival in AML patients.Keywords: hematology, allogeneic transplantation, socioeconomics, prognosis, epidemiology
