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.|
Resectable invasive IPMN versus sporadic pancreatic adenocarcinoma of the head of the pancreas: Should these two different diseases receive the same treatment? A matched comparison study of the French Surgical Association (AFC).
|Journal Title||journal of the american college of surgeons|
|Publication Year Start||2017-01-01|
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.