title: Distance from a Comprehensive Cancer Center: A proxy for poor cervical cancer outcomes?
abstract: OBJECTIVE
  To evaluate the potential relationship between outcomes in cervical cancer patients based on distance from our Comprehensive Cancer Center (CCC).
  
  
  METHODS
  A retrospective cohort study of cervical cancer patients was performed. Abstracted data included: demographics, clinicopathologic variables, treatment, and survival. Analyses both by quartiles and distance <100 and ≥100miles from our institution were performed. Data were analyzed using SAS version 9.2.
  
  
  RESULTS
  390 patients living a median distance of 58.1miles (range 1.2-571miles) from our CCC were identified. Patients were generally white (n=249), non-smokers (n=226), with Stage IB disease (n=222), squamous histology (n=295) and underwent primary surgical therapy (n=229). Patients were divided into both quartiles as well as two strata: <100 and ≥100miles for comparison. Progression-free survival (PFS) and overall survival (OS) favored patients living closer to our center with a lower median OS for patients living ≥100miles (65.4vs. 99.4months; p=0.040). Cox proportional hazard modeling noted that advanced stage was predictive of inferior PFS and OS, while other clinical covariates including age, BMI, race, smoking status and histology had a variable impact on outcomes and distance >100miles was associated with a higher risk of death (hazard ratio [HR]=1.68, 95% confidence interval [CI] 1.11-2.54).
  
  
  CONCLUSIONS
  Overall survival for patients living >100miles from our CCC was worse when compared to patients in closer proximity. Outreach efforts and utilization of navigators may help decrease the impact of geographic and racial disparities on outcomes.
authors.affiliation: University of Alabama, Birmingham Department of Obstetrics & Gynecology, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Barrington
authors.affiliation: University of Alabama, Birmingham Division of Gynecologic Oncology, United States.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Dilley
authors.affiliation: University of Alabama, Birmingham Department of Obstetrics & Gynecology, United States.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Landers
authors.affiliation: University of Alabama, Birmingham Division of Gynecologic Oncology, United States.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Thomas
authors.affiliation: University of Alabama, Birmingham Division of Gynecologic Oncology, United States.
authors.forename: Jonathon D
authors.initials: JD
authors.lastname: Boone
authors.affiliation: University of Alabama, Birmingham Division of Gynecologic Oncology, United States.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Straughn
authors.affiliation: University of Alabama, Birmingham Department of Epidemiology, United States.
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.affiliation: University of Alabama, Birmingham Division of Gynecologic Oncology, United States. Electronic address: cleath@uabmc.edu.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000407:Alabama; D002173:Cancer Care Facilities; D018196:Carcinoma, Adenosquamous / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D054624:Health Status Disparities; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014186:Transportation; D014195:Travel; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy
keywords: Cervical cancer; Disparities; Distance; Survival outcomes