title: Association of Distance Traveled for Surgery with Short- and Long-Term Cancer Outcomes.
abstract: The influence of distance traveled for treatment on short- and long-term cancer outcomes is unclear.
  
  
  
  Patients with colon, esophageal, liver, and pancreas cancer from 2003 to 2006 were identified from the National Cancer Data Base (NCDB). Distance traveled for surgical treatment was estimated using zip code centroids. Propensity scores were generated for probability of traveling farther for treatment. Mixed effects logistic regression for 90-day mortality and Cox regression for 5-year mortality were compared between patients treated regionally and those traveling from farther away.
  
  
  
  The mean distance traveled for all patients for surgical resection was 30.0 ± 227 miles, with a median distance of 7.5 (interquartile range 14.4) miles. Patients who were aged ≥80 years, on Medicaid, or African American were less likely to be in the fourth quartile of distance (Q4) traveled for surgery. Patients who were in Q4 had a lower risk-adjusted 90-day mortality compared to Q1 for colon [odds ratio (OR) 0.89, 95 % confidence interval (CI) 0.82-0.96], liver (OR 0.49, 95 % CI 0.3-0.78), and pancreatic (OR 0.74, 95 % CI 0.56-0.98) cancer. Similarly, patients in Q4 for all tumor types had a lower risk-adjusted 5-year mortality compared to patients in Q1; colon (hazard ratio (HR) 0.96, 95 % CI 0.93-0.99), esophagus (HR 0.84, 95 % CI 0.75-0.94), liver (HR 0.75, 95 % CI 0.62-0.89), and pancreas (HR 0.87, 95 % CI 0.80-0.95).
  
  
  
  Greater travel distance for surgical resection of gastrointestinal cancers is associated with lower 90-day and 5-year mortality outcomes. This distance bias has implications for regionalization and reporting of cancer outcomes.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, USA. wasif.nabil@mayo.edu.|Surgical Outcomes Division, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, USA. wasif.nabil@mayo.edu.
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.affiliation: Department of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA.|Surgical Outcomes Division, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, USA.
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, USA.|Surgical Outcomes Division, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, USA.|Surgical Outcomes Division, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, USA.
authors.forename: David
authors.initials: D
authors.lastname: Etzioni
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D014195:Travel / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology