title: Association of distance to treatment facility on quality and survival outcomes after radical cystectomy for bladder cancer.
abstract: OBJECTIVE
  To examine the association of travel distance on quality and survival outcome measures for bladder cancer patients undergoing radical cystectomy for urothelial carcinoma.
  
  
  METHODS
  Four hundred eight patients who underwent radical cystectomy for bladder cancer at a single institution from 2007 to 2013 were included. Multivariate logistic regression was used to determine the association of distance from treatment facility with 90-day mortality and quality-of-care endpoints including neoadjuvant chemotherapy use and time to cystectomy. Survival was assessed by multivariate Cox regression.
  
  
  RESULTS
  Fifty-seven percent of patients lived within 50 miles of the treatment facility. There was no difference in time to cystectomy or the utilization of neoadjuvant chemotherapy between patients in different distance groups. On multivariate analysis, distance to treatment facility was the only predictor of 90-day mortality (odds ratio, 11.20; 95% confidence interval, 2.27-55.43; P = .003, for patients traveling >150 vs <50 miles). Although there was no difference in recurrence and cancer-specific survival between distance groups, greater distance was associated with worse overall survival on multivariate analysis (hazard ratio, 1.59; 95% confidence interval, 0.99-2.56; P = .05, for patients traveling >150 vs <50 miles).
  
  
  CONCLUSIONS
  Distance to treatment facility did not impact quality measures including time to cystectomy or use of neoadjuvant chemotherapy, and there was no difference in cancer-specific mortality between distance groups. There was a detrimental association of increased travel distance with 90-day mortality, which could reflect disparities in access to care after cystectomy.
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Ahmed Q
authors: AQ
authors: Haddad
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Nirmish
authors: N
authors: Singla
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Neil
authors: N
authors: Gupta
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Ganesh V
authors: GV
authors: Raj
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Arthur I
authors: AI
authors: Sagalowsky
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Vitaly
authors: V
authors: Margulis
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Yair.Lotan@utsouthwestern.edu.
authors: Yair
authors: Y
authors: Lotan
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015653:Cystectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D011787:Quality of Health Care; D015996:Survival Rate; D061665:Time-to-Treatment / Q000592:standards; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*