The impact of traveling distance and hospital volume on post-surgical outcomes for patients with glioblastoma

• DOI: 10.1007/s11060-018-03022-w
• Publication Date: 2018-11-20T14:19:23Z
• Authors: Christian Lopez R...; Michael G. Brandel; Jeffrey A. Steinberg; Arvin R. Wali; Robert C. Rennert; David R. Santiago...; Reith R. Sarkar; J. Scott Pannell; James D. Murphy; Alexander A. Khal...
• Keywords: Male; Travel; Hospitals, Low-Volume; Brain Neoplasms; Kaplan-Meier Estimate; Middle Aged; Health Services Accessibility; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Humans; Female; Postoperative Period; Glioblastoma; Hospitals, High-Volume; Aged

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.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.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).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.