M. Raoof1, P. H. Ituarte1, S. G. Warner1, Y. Woo1, G. Singh1, Y. Fong1, L. Melstrom1 1City Of Hope Comprehensive Cancer Center,Surgery,Duarte, CA, USA
Introduction: Centralization of complex cancer surgery is associated with improved outcomes and recent data demonstrate extensive centralization over the past two decades. We hypothesize that certain patient factors and travel distance impose significant barriers to seeking pancreatic cancer surgery at high-volume centers.
Methods: Using the National Cancer Database (NCDB), we analyzed patients undergoing pancreatic resections over a ten-year period (2003-2014). Socioeconomic and clinico-pathologic variables were compared between patients treated at high-volume centers (HVC, >25 cases/yr) or low-volume centers (LVC, <25 cases/yr). Multiple logistic regression was used to identify predictors of care at HVCs.
Results: A total of 35,804 eligible patients underwent pancreatic resections at 941 different hospitals. Independent predictors of pancreatic resection at HVC are summarized in Table1. Patients treated at HVCs traveled farther (Median 38.3 miles, IQR: 15.2-94.9) compared to those treated at LVCs (Median 13 miles, IQR: 5.4-35.1, p=0.0001). Ninety-day mortality was associated with distance traveled (9% for 0-10 miles vs. 6.9% for >10 miles, p<0.001). Of the patients treated at HVCs, those traveling >10miles had similar 90-day mortality to those traveling 0-10 miles (5.7% vs. 5.3%, p=0.5). These patients who travel >10 miles, are less likely to be old i.e.>60 years (OR 0.86, p=0.03), Black (OR 0.24,p<0.001), Hispanic (OR 0.25,p<0.001) and more likely to be from high income (OR 1.44,p<0.001) or high education county (OR 1.5,p<0.001).
Conclusion: Travel distance is a major barrier in access to centralized pancreatic cancer surgery, underlying significant socioeconomic and racial disparities. Patients that are able to travel farther have increased access to HVCs and lower mortality.
