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. 2016 Dec;143(3):617-621.
doi: 10.1016/j.ygyno.2016.10.004. Epub 2016 Oct 6.

Distance from a Comprehensive Cancer Center: A proxy for poor cervical cancer outcomes?

David A Barrington  1 , Sarah E Dilley  2 , Emily E Landers  1 , Eric D Thomas  2 , Jonathon D Boone  2 , J Michael Straughn Jr  2 , Gerald McGwin Jr  3 , Charles A Leath 3rd  4
Affiliations

Distance from a Comprehensive Cancer Center: A proxy for poor cervical cancer outcomes?

David A Barrington et al. Gynecol Oncol. 2016 Dec.

Abstract

Objective: To evaluate the potential relationship between outcomes in cervical cancer patients based on distance from our Comprehensive Cancer Center (CCC).

Methods: A retrospective cohort study of cervical cancer patients was performed. Abstracted data included: demographics, clinicopathologic variables, treatment, and survival. Analyses both by quartiles and distance <100 and ≥100miles from our institution were performed. Data were analyzed using SAS version 9.2.

Results: 390 patients living a median distance of 58.1miles (range 1.2-571miles) from our CCC were identified. Patients were generally white (n=249), non-smokers (n=226), with Stage IB disease (n=222), squamous histology (n=295) and underwent primary surgical therapy (n=229). Patients were divided into both quartiles as well as two strata: <100 and ≥100miles for comparison. Progression-free survival (PFS) and overall survival (OS) favored patients living closer to our center with a lower median OS for patients living ≥100miles (65.4vs. 99.4months; p=0.040). Cox proportional hazard modeling noted that advanced stage was predictive of inferior PFS and OS, while other clinical covariates including age, BMI, race, smoking status and histology had a variable impact on outcomes and distance >100miles was associated with a higher risk of death (hazard ratio [HR]=1.68, 95% confidence interval [CI] 1.11-2.54).

Conclusion: Overall survival for patients living >100miles from our CCC was worse when compared to patients in closer proximity. Outreach efforts and utilization of navigators may help decrease the impact of geographic and racial disparities on outcomes.

Keywords: Cervical cancer; Disparities; Distance; Survival outcomes.

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Conflict of interest statement

The authors affirm that they have no conflicts of interest for the current manuscript.

Figures

Figure 1
Figure 1
Geographic distribution heat map of patient residences
Figure 2
Figure 2
Progression-free survival based on distance from NCCN cancer center
Figure 3
Figure 3
Overall survival based on distance from NCCN cancer center
See this image and copyright information in PMC

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