In the patient’s shoes: The impact of hospital proximity and volume on stage I endometrial cancer care patterns and outcomes

• Published in: Gynecologic oncology Vol. 182; pp. 91 - 98
• Main Authors: Wang, Connor C., Bharadwa, Sonya, Domenech, Issac, Barber, Emma L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: Endometrial cancer; Endometrial Neoplasms - surgery; Female; Hospital proximity; Hospital surgical volume; Hospitals, High-Volume; Humans; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Retrospective Studies; Stage I endometrial cancer; Surgical outcomes; Travel, burden; Treatment Outcome; Surgical outcomes; Travel, burden; Stage I endometrial cancer; Endometrial cancer; Hospital surgical volume; Hospital proximity
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2024.01.003

To compare the impact of travel burden and hospital volume on care patterns and outcomes in stage I endometrial cancer. This retrospective cohort study identified patients from the National Cancer Database with stage I epithelial endometrial carcinoma who underwent hysterectomy between 2012 and 2020. Patients were categorized into: lowest quartiles of travel distance and hospital surgical volume for endometrial cancer (Local) and highest quartiles of distance and volume (Travel). Primary outcome was overall survival. Secondary outcomes were surgery route, lymph node (LN) assessment method, length of stay (LOS), 30-day readmission, and 30- and 90-day mortality. Results were stratified by tumor recurrence risk. Outcomes were compared using propensity-score matching. Propensity-adjusted survival was evaluated using Kaplan-Meier curves and compared using log-rank tests. Cox models estimated hazard ratios for death. Sensitivity analysis using modified Poisson regressions was performed. Among 36,514 patients, 51.4% were Local and 48.6% Travel. The two cohorts differed significantly in demographics and clinicopathologic characteristics. Upon propensity-score matching (p < 0.05 for all), more Travel patients underwent minimally invasive surgery (88.1%vs79.1%) with fewer conversions to laparotomy (2.0%vs2.6%), more sentinel (20.5%vs11.3%) and fewer traditional LN assessments (58.1vs61.7%) versus Local. Travel patients had longer intervals to surgery (≥30 days:56.7%vs50.1%) but shorter LOS (<2 days:76.9%vs59.8%), fewer readmissions (1.9%vs2.7%%), and comparable 30- and 90-day mortality. OS and HR for death remained comparable between the matched groups. Compared to surgery in nearby low-volume hospitals, patients with stage I epithelial endometrial cancer who travelled longer distances to high-volume centers experienced more favorable short-term outcomes and care patterns with comparable long-term survival. •Travel burden and hospital volume influence care and outcomes for patients with stage I endometrial cancers.•Patients who travel greater distance to high-volume hospitals have more favorable short-term outcomes.•Patients at nearby, low-volume hospitals undergo less minimally invasive surgeries and sentinel lymph node biopsies.•There was comparable long-term survival in nearby low-volume hospitals vs distant high-volume hospitals.•The short-term benefits of high-volume hospitals highlight the value of specialized care for stage I endometrial cancer.