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. 2016 Jul;22(7):1319-1323.
doi: 10.1016/j.bbmt.2016.03.019. Epub 2016 Mar 22.

Association of Distance from Transplantation Center and Place of Residence on Outcomes after Allogeneic Hematopoietic Cell Transplantation

Nandita Khera  1 , Ted Gooley  2 , Mary E D Flowers  2 , Brenda M Sandmaier  2 , Fausto Loberiza  3 , Stephanie J Lee  2 , Frederick Appelbaum  2
Affiliations

Association of Distance from Transplantation Center and Place of Residence on Outcomes after Allogeneic Hematopoietic Cell Transplantation

Nandita Khera et al. Biol Blood Marrow Transplant. 2016 Jul.

Abstract

Regionalization of specialized health services can deliver high-quality care but may have an adverse impact on access and outcomes because of distance from the regional centers. In the case of hematopoietic cell transplantation (HCT), the effect of increased distance between the transplantation center and the rural/urban residence is unclear because of conflicting results from the existing studies. We examined the association between distance from primary residence to the transplantation center and rural versus urban residence with clinical outcomes after allogeneic HCT in a large cohort of patients. Overall mortality (OM), nonrelapse mortality (NRM), and relapse in all patients and those who survived for 200 days after HCT were assessed in 2849 patients who received their first allogeneic HCT between 2000 and 2010 at Fred Hutchinson Cancer Research Center (FHCRC)/Seattle Cancer Care Alliance. Median distance from FHCRC was 263 miles (range, 0 to 2740 miles) and 83% of patients were urban residents. The association between distance and the hazard of OM varied according to conditioning intensity: myeloablative (MA) versus nonmyeloablative (NMA). Among MA patients, there was no evidence of an increased risk of mortality with increased distance, but for NMA patients, the results did show a suggestion of increased risk of mortality for some distances, although globally the difference was not statistically significant. In the subgroup of patients who survived 200 days, there was no evidence that the risks of OM, relapse, or NRM were increased with increasing distance. We did not find any association between longer distance from transplantation center and urban/rural residence and outcomes after MA HCT. In patients undergoing NMA transplantations, this relationship and how it is influenced by factors such as age, payers, and comorbidities needs to be further investigated.

Keywords: Allogeneic hematopoietic cell transplantation; Distance; Residence.

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Figures

Figure 1
Figure 1
Hazard ratio of overall mortality as a non-linear function of distance from transplant Center. Solid curve represents the hazard of death at a particular distance (as given on the x-axis) relative to the hazard of death at a distance of zero (i.e., same zip code as the transplant Center). Dotted curves represent the lower and upper 95% pointwise confidence limits of the hazard ratio at a given distance. A: Overall mortality in all patients receiving myeloablative HCT. B: Overall mortality in all patients receiving non-myeloablative HCT
Figure 1
Figure 1
Hazard ratio of overall mortality as a non-linear function of distance from transplant Center. Solid curve represents the hazard of death at a particular distance (as given on the x-axis) relative to the hazard of death at a distance of zero (i.e., same zip code as the transplant Center). Dotted curves represent the lower and upper 95% pointwise confidence limits of the hazard ratio at a given distance. A: Overall mortality in all patients receiving myeloablative HCT. B: Overall mortality in all patients receiving non-myeloablative HCT
See this image and copyright information in PMC

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