Introduction

Patients living farther away from academic centers may not have easy access to resources for management of acute myeloid leukemia (AML). We aimed to analyze the effect of distance traveled on overall survival (OS) of AML patients treated at an academic center.

Patients and Methods

AML patients diagnosed at the University of Nebraska Medical Center were divided into 4 groups according to the shortest distance between the cancer center and patients’ residence (<25, 25-50, 50-100, and > 100 miles). Chi-square test and ANOVA were used to examine the association of distance with patient characteristics. OS, defined as the time from diagnosis of AML to death from any cause, was determined by the Kaplan-Meier method. Comparison of survival curves was done by the log-rank test. Multivariable analysis using Cox regression was performed to detect the survival effect of distance from the cancer center.

Results

The total number of patients was 449. Median distance was 85 miles (interquartile range, 20-180). OS at 1 year for < 25, 25-50, 50-100, and > 100 miles was 45%, 55%, 38%, and 40% respectively (P = .6). In a Cox regression analysis, distance from treatment center, as a continuous variable, was not a significant factor for death (hazard ratio, 1.001; 95% confidence interval, 1.000-1.001). Multivariable analysis showed nonsignificant trend of increased mortality for patients traveling > 100 miles to a cancer center.

Conclusion

This study did not demonstrate an association between distance from an academic cancer center and OS in AML. This finding should provide some assurance to patients who live farther away from academic centers.

中文翻译：

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距学术癌症中心的距离对急性髓系白血病总体生存率的影响：治疗患者的回顾性分析。

介绍

居住距离学术中心较远的患者可能无法轻松获得治疗急性髓系白血病 (AML) 的资源。我们的目的是分析旅行距离对在学术中心接受治疗的 AML 患者总生存期 (OS) 的影响。

患者和方法

内布拉斯加大学医学中心诊断的 AML 患者根据癌症中心与患者住所之间的最短距离（<25、25-50、50-100 和 > 100 英里）分为 4 组。卡方检验和方差分析用于检查距离与患者特征的关联。OS 定义为从诊断 AML 到因任何原因死亡的时间，通过 Kaplan-Meier 方法确定。通过对数秩检验来比较生存曲线。使用 Cox 回归进行多变量分析，以检测距癌症中心距离的生存影响。

结果

患者总数为 449 人。中位距离为 85 英里（四分位距，20-180）。< 25、25-50、50-100 和 > 100 英里的 1 年 OS 分别为 45%、55%、38% 和 40% ( P  = .6)。在 Cox 回归分析中，距治疗中心的距离作为连续变量，并不是死亡的显着因素（风险比，1.001；95% 置信区间，1.000-1.001）。多变量分析显示，前往癌症中心 100 英里以上的患者死亡率增加的趋势不显着。

结论

这项研究并未证明距学术癌症中心的距离与 AML 的 OS 之间存在关联。这一发现应该为居住在距离学术中心较远的患者提供一些保证。