Association of travel distance, surgical volume, and receipt of adjuvant chemotherapy with survival among patients with resectable lung cancer.

Logan CD, Ellis RJ, Feinglass J, Halverson AL, Avella D, Lung K, Kim S, Bharat A, Merkow RP, Bentrem DJ, Odell DD. Association of travel distance, surgical volume, and receipt of adjuvant chemotherapy with survival among patients with resectable lung cancer. JTCVS open. 2023 Mar 1; 13:357-378.

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Abstract:

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 (  <  .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.