Association of travel distance, surgical volume, and receipt of adjuvant chemotherapy with survival among patients with resectable lung cancerCentral MessagePerspective
Charles D. Logan, MD,
Ryan J. Ellis, MD, MS,
Joe Feinglass, PhD,
Amy L. Halverson, MD,
Diego Avella, MD,
Kalvin Lung, MD,
Samuel Kim, MD,
Ankit Bharat, MBBS,
Ryan P. Merkow, MD, MS,
David J. Bentrem, MD, MS,
David D. Odell, MD, MMSc
Affiliations
Charles D. Logan, MD
Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
Ryan J. Ellis, MD, MS
Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
Joe Feinglass, PhD
Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Ill
Amy L. Halverson, MD
Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
Diego Avella, MD
Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
Kalvin Lung, MD
Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
Samuel Kim, MD
Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
Ankit Bharat, MBBS
Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
Ryan P. Merkow, MD, MS
Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
David J. Bentrem, MD, MS
Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Surgery Service, Jesse Brown VA Medical Center, Chicago, Ill
David D. Odell, MD, MMSc
Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Address for reprints: David D. Odell, MD, MMSc, Department of Surgery, Surgical Outcomes and Quality Improvement Center, Northwestern University, Feinberg School of Medicine, 633 N St Clair St, 20th Floor, Chicago, IL 60611.
Objective: Regionalization of surgery for non–small cell lung cancer (NSCLC) to high-volume centers (HVCs) improves perioperative outcomes but frequently increases patient travel distance. Travel might decrease rates of adjuvant chemotherapy (AC) use, however, the relationship of distance, volume, and receipt of AC with outcomes is unknown. Our objective was to evaluate the association of distance, volume, and receipt of AC with overall survival among patients with NSCLC. Methods: Patients with stage I to IIIA (N0-N1) NSCLC were identified between 2004 and 2018 using the National Cancer Database. Distance to surgical facility was categorized into quartiles (<5.1, 5.1 to <11.5, 11.5 to <28.1, and ≥28.1 miles), and HVCs were defined as those that perform ≥40 annual resections. Patient characteristics and likelihood of receiving AC anywhere were determined. Propensity score-matched survival analysis was performed using Cox models and Kaplan–Meier curves. Results: Of the 131,982 patients included, 35,658 (27.0%) were stage II to IIIA. Of the stage II to IIIA cohort, 49.6% received AC, 13.1% traveled <5.1 miles to low-volume centers (LVCs), and 18.1% traveled ≥28.1 miles to HVCs (P < .001). Among stage II to IIIA patients who traveled ≥28.1 miles to HVCs, 45% received AC versus 51.5% who traveled <5.1 miles to LVCs (incidence rate ratio, 0.88; 95% CI, 0.83-0.94; <5.1 miles to LVC reference). Patients with stage II to IIIA NSCLC who traveled ≥28.1 miles to HVCs and did not receive AC had higher mortality rates than those who traveled <5.1 miles to LVCs and received AC (median overall survival, 52.3 vs 36.7 months; adjusted hazard ratio, 1.41; 95% CI, 1.26-1.57). Conclusions: Increasing travel distance to surgical treatment is associated with decreased likelihood of receiving AC for patients with stage II to IIIA (N0-N1) NSCLC.
