Longer distance to specialized treatment centers does not adversely affect treatment intensity or outcomes in adult acute myeloid leukemia patients. A Danish national population-based cohort study

• Published in: Clinical epidemiology Vol. 11; pp. 769 - 780
• Main Authors: Tøstesen, Michael, Nørgaard, Mette, Nørgaard, Jan Maxwell, Medeiros, Bruno C, Marcher, Claus Werenberg, Overgaard, Ulrik Malthe, Severinsen, Marianne Tang, Schoellkopf, Claudia, Østgård, Lene Sofie Granfeldt
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.08.2019; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Acute myelocytic leukemia; allogeneic transplantation; Analysis; Cancer research; Cancer treatment; Care and treatment; Chemotherapy; Clinical medicine; Cohort analysis; Drug dosages; Epidemiology; Hematology; Hospitals; Leukemia; Medical research; Myeloid leukemia; Original Research; Patient outcomes; Patients; Population; Population-based studies; prognosis; Regression analysis; Socioeconomics; Stem cells; Studies; Surgery; Transplants & implants; Denmark; Aarhus Denmark; epidemiology; hematology; allogeneic transplantation; socioeconomics; prognosis
• ISSN: 1179-1349; 1179-1349
• DOI: 10.2147/CLEP.S210456

Treatment of acute myeloid leukemia (AML) is widely centralized. Longer distances to a specialized treatment center may affect patients' access to curative-intended treatment. Especially during outpatient treatment, distance may also affect survival. The authors conducted a national population-based cohort study including all AML patients diagnosed in Denmark between 2000 and 2014. We investigated effects of distance (<10 kilometers [km; reference], 10-25, 25-50, 50-100, >100) to the nearest specialized treatment facility on the probability of receiving intensive chemotherapy, HSCT, and achieving a complete remission (CR) using logistic regression analysis (odds ratios; ORs). For overall survival, we used Cox proportional hazards regression (hazard ratios [HRs]) and adjusted (a) for relevant baseline characteristics. Of 2,992 patients (median age=68.5 years), 53% received intensive chemotherapy and 12% received low-dose chemotherapy outpatient regimens. The median distance to a specialized treatment center was 40 km (interquartile range=10-77 km). No impact of distance to specialized treatment centers was seen on the probability of receiving intensive chemotherapy (10-25 km, aOR=1.1 (CI=0.7-1.7), 25-50 km, aOR=1.1 (CI=0.7-1.7), 50-100 km, aOR=1.3 (CI=0.9-1.9), and >100 km, aOR=1.4 [CI=0.9-2.2]). Overall survival in patients regardless of therapy (<10 km, aOR=1.0 vs >100 km, aOR=1.0 [CI=0.9-1.2]), in intensive therapy patients, or in patients' choice of post-remission was not affected by distance to specialized treatment center. Distance to a transplant center also did not affect the probability of HSCT or survival post-HSCT. In Denmark, distance to a specialized treatment facility offering remission-induction chemotherapy and HSCT does not negatively affect access to curative-indented therapy, treatment-response, or survival in AML patients.