Background: 

Clinical practice guidelines recommend centralized care for patients with bone sarcoma. However, the relationship between the distance that patients travel to obtain care, institutional treatment volume, and survival is unknown.

Methods: 

We used the National Cancer Database to examine associations between travel distance and survival among 8,432 patients with bone sarcoma diagnosed from 2004 to 2015. Associations were identified using multivariable Cox regression analyses that controlled for sociodemographic, clinical, and hospital-level factors; subgroup analyses stratified patients by histological diagnosis, tumor stage, and pediatric or adult status.

Results: 

Mortality risk was lower among patients who traveled ≥50 miles (≥80.5 km) than among patients who traveled ≤10 miles (≤16.1 km) (hazard ratio [HR], 0.69 [95% confidence interval (CI), 0.63 to 0.76]). Among hospital-level factors, facility volume independently affected survival: mortality risk was lower among patients at high-volume facilities (≥20 cases per year) than at low-volume facilities (≤5 cases per year), with an HR of 0.72 (95% CI, 0.66 to 0.80). The proportion of patients who received care at high-volume facilities varied by distance traveled (p < 0.001); it was highest among patients who traveled ≥50 miles (53%) and lower among those who traveled 11 to 49 miles (17.7 to 78.9 km) (32%) or ≤10 miles (18%). Patients who traveled ≥50 miles to a high-volume facility had a lower risk of mortality (HR, 0.65 [95% CI, 0.56 to 0.77]) than those who traveled ≤10 miles to a low-volume facility. In subgroup analyses, this association was evident among patients with all 3 major histological subtypes; those with stage-I, II, and IV tumors; and adults.

Conclusions: 

This national study showed that greater travel burden was associated with higher survival rates in adults, a finding attributable to patients traveling to receive care at high-volume facilities. Despite the burdens associated with travel, modification of referral pathways to specialized centers may improve survival for patients with bone sarcoma.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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骨肉瘤患者获得大量护理服务的地理范围和生存率：美国全国范围内的模式

背景： 

临床实践指南建议对骨肉瘤患者进行集中护理。然而，患者获得护理的出行距离、机构治疗量和生存率之间的关系尚不清楚。

方法： 

我们使用国家癌症数据库检查了 2004 年至 2015 年诊断的 8,432 名骨肉瘤患者的旅行距离和生存率之间的关联。通过控制社会人口统计学、临床和医院层面因素的多变量 Cox 回归分析来确定关联；亚组分析按组织学诊断、肿瘤分期以及儿童或成人状态对患者进行分层。

结果： 

出行距离≥50英里（≥80.5公里）的患者的死亡风险低于出行≤10英里（≤16.1公里）的患者（风险比[HR]，0.69 [95%置信区间（CI），0.63至0.76] ）。在医院层面的因素中，设施容量独立影响生存：高容量设施（每年≥20例）的患者死亡风险低于低容量设施（每年≤5例）的患者死亡风险，HR为0.72（ 95% CI，0.66 至 0.80）。在大容量设施接受护理的患者比例因出行距离而异（p < 0.001）；出行距离≥50英里的患者中该比例最高（53%），出行距离11至49英里（17.7至78.9公里）的患者中比例较低（32%），或≤10英里的患者中比例较低（18%）。与前往低流量设施的行程 ≤ 10 英里的患者相比，行驶 ≥ 50 英里前往高流量设施的患者的死亡风险较低（HR，0.65 [95% CI，0.56 至 0.77]）。在亚组分析中，这种关联在所有 3 种主要组织学亚型的患者中都很明显。患有 I、II 和 IV 期肿瘤的患者；和成人。

结论： 

这项全国性研究表明，较大的旅行负担与成人较高的生存率相关，这一发现归因于患者前往大容量设施接受护理。尽管存在与旅行相关的负担，但改变转诊至专科中心的途径可能会提高骨肉瘤患者的生存率。

证据级别： 

预后III 级。有关证据级别的完整描述，请参阅作者须知。