Introduction: High-volume hospitals are associated with improved outcomes in patients with glioblastoma (GBM). However, less is known regarding the impact of travel burden to high-volume centers. We examined post-operative outcomes between patients that underwent GBM treatment at local, low-volume hospitals with those that traveled long distances to high-volume institutions.
Methods: The National Cancer Database was queried for GBM patients that underwent surgery (2011 to 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 distance and volume (Long-travel/High-Volume: LTHV). Outcomes analyzed were 90-day mortality, overall survival, readmission, and length of stay.
Results: A total of 35,495 cases met inclusion criteria. STLV patients (n=3,414) 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=3,808) traveled a median of 62 miles [44.1-111.3] to high-volume centers (48 [42-71] annual cases). LTHV patients were younger (61 vs 64 median age), had a lower Charlson comorbidity index, were more likely to receive treatment at academic research centers (84.4% vs 11.9%), and were less likely to be a racial minority (8.1% vs 17.1%) or underinsured (6.9% vs 12.1%; all p <0.001). LTHV patients were also more likely to receive trimodality therapy (surgery, chemotherapy, and radiotherapy [75.6% vs 69.2%, p <0.001]). On multivariable analysis, overall survival was higher for LTHV patients (HR 0.87, p=0.002). LTHV predicted decreased 90-day mortality (OR=0.72, p=0.019), readmission (OR 0.42, p <0.001), and hospital length of stay (RR=0.79, p <0.001).
Conclusions: Glioblastoma patients who travel farther to high-volume centers have better overall survival and postoperative outcomes compared to patients who receive treatment locally at low-volume hospitals. Efforts to support patient travel to high-volume institutions and centralization of care may improve outcomes for GBM patients.
Patient Care: Efforts to support patient travel to high-volume institutions and centralization of care may improve outcomes for GBM patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the impact of travel distance to treatment centers and hospital volume on surgical outcomes for patients with glioblastoma 2) Describe patient, clinical, and hospital characteristics associated with travel distance and hospital volume. 3) Discuss the importance on outcomes in the regionalization of GBM care.