J Neurooncol. 2018 Nov 20. doi: 10.1007/s11060-018-03022-w. [Epub ahead of print]

Lopez Ramos C1, Brandel MG1, Steinberg JA1, Wali AR1, Rennert RC1, Santiago-Dieppa DR1, Sarkar RR2, Pannell JS1, Murphy JD2, Khalessi AA3 .

 

Author information:

1. Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA.

2. Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA.

3. Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA. akhalessi@ucsd.edu.

Abstract

BACKGROUND:

 

High-volume hospitals are associated with improved outcomes in glioblastoma (GBM). However, the impact of travel burden to high-volume centers is poorly understood. We examined post-operative outcomes between GBM patients that underwent treatment at local, low-volume hospitals with those that traveled long distances to high-volume hospitals.

METHODS:

 

The National Cancer Database was queried for GBM patients that underwent surgery (2010-2014). We established two cohorts: patients in the lowest quartile of travel distance and volume (Short-travel/Low-Volume: STLV) and patients in the highest quartile of travel and volume (Long-travel/High-Volume: LTHV). Outcomes analyzed were 30-day, 90-day mortality, overall survival, 30-day readmission, and hospital length of stay.

RESULTS:

 

Of 35,529 cases, STLV patients (n = 3414) traveled a median of 3 miles (Interquartile range [IQR] 1.8-4.2) to low-volume centers (5 [3-7] annual cases) and LTHV patients (n = 3808) traveled a median of 62 miles [44.1-111.3] to high-volume centers (48 [42-71]). LTHV patients were younger, had lower Charlson scores, largely received care at academic centers (84.4% vs 11.9%), were less likely to be minorities (8.1% vs 17.1%) or underinsured (6.9% vs 12.1), and were more likely to receive trimodality therapy (75.6% vs 69.2%; all p < 0.001). On adjusted analysis, LTHV predicted improved overall survival (HR 0.87, p = 0.002), decreased 90-day mortality (OR 0.72, p = 0.019), lower 30-day readmission (OR 0.42, p < 0.001), and shorter hospitalizations (RR 0.79, p < 0.001).

CONCLUSIONS:

 

Glioblastoma patients who travel farther to high-volume centers have superior post-operative outcomes compared to patients who receive treatment locally at low-volume centers. Strategies that facilitate patient travel to high-volume hospitals may improve outcomes.

PMID: 30460629