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A Tale of Two Cancers: Traveling to Treat Pancreatic and Thyroid Cancer.

Abstract Patients diagnosed with a malignancy must decide whether to travel for care at an academic center or receive treatment at a nearby hospital. Here we examine differences in demographics, treatment, and outcomes of those traveling to academic centers for their care vs those not traveling, as well as compare travel for an aggressive vs indolent malignancy.
PMID
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Authors

Mayor MeshTerms

Travel

Keywords
Journal Title journal of the american college of surgeons
Publication Year Start




PMID- 28473189
OWN - NLM
STAT- MEDLINE
DA  - 20170505
DCOM- 20170825
LR  - 20170825
IS  - 1879-1190 (Electronic)
IS  - 1072-7515 (Linking)
VI  - 225
IP  - 1
DP  - 2017 Jul
TI  - A Tale of Two Cancers: Traveling to Treat Pancreatic and Thyroid Cancer.
PG  - 125-136.e6
LID - S1072-7515(17)30268-5 [pii]
LID - 10.1016/j.jamcollsurg.2017.02.017 [doi]
AB  - BACKGROUND: Patients diagnosed with a malignancy must decide whether to travel
      for care at an academic center or receive treatment at a nearby hospital. Here we
      examine differences in demographics, treatment, and outcomes of those traveling
      to academic centers for their care vs those not traveling, as well as compare
      travel for an aggressive vs indolent malignancy. STUDY DESIGN: All patients with 
      papillary thyroid carcinoma (PTC) or pancreatic ductal adenocarcinoma (PDAC)
      undergoing surgical resection and in the National Cancer Database were examined. 
      Travel for care was abstracted from "crowfly" distance between patients' ZIP
      codes and treatment facility, region, county size, urban/metro/rural status, and 
      facility type. RESULTS: In total, 105,677 patients with PTC and 22,983 patients
      with PDAC were analyzed. There were no survival differences by travel in the PTC 
      group. Survival was improved for patients with PDAC traveling from urban/rural
      settings (hazard ratio = 0.89; 95% CI 0.82 to 0.96; p = 0.002). Patients
      traveling with PDAC were more likely to have a complete resection and lymph node 
      dissection. Those traveling were less likely to receive chemotherapy or
      radiotherapy (all p < 0.001). Those traveling with PTC were older, more likely to
      be male, have Medicare insurance, and had a higher stage of disease (all p <
      0.001). Rates of radioactive iodine were lower, American Thyroid Association
      guidelines were more likely followed, and lymph node dissection was more common
      for those traveling for care of their PTC (all p < 0.001). CONCLUSIONS: There are
      improvements in both quality and survival for those traveling to academic centers
      for their cancer care. In the case of PTC, this difference in quality did not
      affect overall survival. In PDAC, however, differences in quality translated to a
      survival advantage.
CI  - Copyright (c) 2017 American College of Surgeons. Published by Elsevier Inc. All
      rights reserved.
FAU - White, Michael G
AU  - White MG
AD  - Department of Surgery, Endocrine Surgery Research Group, Chicago, IL.
FAU - Applewhite, Megan K
AU  - Applewhite MK
AD  - Department of Surgery, Albany Medical College, Albany, NY.
FAU - Kaplan, Edwin L
AU  - Kaplan EL
AD  - Department of Surgery, Endocrine Surgery Research Group, Chicago, IL.
FAU - Angelos, Peter
AU  - Angelos P
AD  - Department of Surgery, Endocrine Surgery Research Group, Chicago, IL.
FAU - Huo, Dezheng
AU  - Huo D
AD  - Department of Public Health Sciences, University of Chicago, Chicago, IL.
FAU - Grogan, Raymon H
AU  - Grogan RH
AD  - Department of Surgery, Endocrine Surgery Research Group, Chicago, IL. Electronic 
      address: [email protected]
LA  - eng
PT  - Journal Article
DEP - 20170501
PL  - United States
TA  - J Am Coll Surg
JT  - Journal of the American College of Surgeons
JID - 9431305
SB  - AIM
SB  - IM
MH  - Academic Medical Centers
MH  - Adenocarcinoma/*surgery
MH  - Aged
MH  - Carcinoma, Pancreatic Ductal/pathology/*therapy
MH  - Carcinoma, Papillary/pathology/*therapy
MH  - Comorbidity
MH  - Female
MH  - Health Services Accessibility
MH  - Humans
MH  - Lymph Node Excision
MH  - Lymphatic Metastasis
MH  - Male
MH  - Neoplasm Staging
MH  - Pancreatic Neoplasms/pathology/*therapy
MH  - Thyroid Neoplasms/pathology/*therapy
MH  - Thyroidectomy
MH  - *Travel
MH  - Treatment Outcome
EDAT- 2017/05/06 06:00
MHDA- 2017/08/26 06:00
CRDT- 2017/05/06 06:00
PHST- 2016/12/09 [received]
PHST- 2017/02/18 [revised]
PHST- 2017/02/20 [accepted]
AID - S1072-7515(17)30268-5 [pii]
AID - 10.1016/j.jamcollsurg.2017.02.017 [doi]
PST - ppublish
SO  - J Am Coll Surg. 2017 Jul;225(1):125-136.e6. doi:
      10.1016/j.jamcollsurg.2017.02.017. Epub 2017 May 1.