Travel distance is associated with stage at presentation and laryngectomy rates among patients with laryngeal cancer.
J Surg Oncol
; 124(8): 1272-1283, 2021 Dec.
Article
in En
| MEDLINE
| ID: mdl-34390494
ABSTRACT
BACKGROUND:
The impact of travel distance on stage at presentation and management strategies of laryngeal squamous cell carcinoma (SCC) is unknown. We investigated this relationship.METHODS:
Retrospective review of patients with laryngeal SCC in the National Cancer Data Base from 2004 to 2016. Multivariate analysis determined relationships between travel distance, sociodemographic, geographic, and hospital factors. Logistic regression determined the influence of travel distance on T-stage and overall stage at presentation, and receipt of total laryngectomy.RESULTS:
Sixty thousand four hundred and thirty-nine patients were divided into groups based on distance to treatment short (<12.5 miles); intermediate (12.5-49.9 miles); and long (>50 miles). Increased travel was associated with T4-stage (intermediate vs. short OR 1.11, CI 1.04-1.18, p = 0.001; long vs. short OR 1.5, CI 1.36-1.65, p < 0.001), and total laryngectomy (intermediate vs. short OR 1.40, CI 1.3-1.5, p ≤ 0.001; long vs. short OR 2.52, CI 2.28-2.79, p ≤ 0.001). In T4 disease, total laryngectomy was associated with improved survival compared to nonsurgical treatment (HR 0.75, CI 0.70-0.80, p < 0.001) regardless of travel distance.CONCLUSION:
Longer travel distance to care is associated with increased stage at presentation, rate of laryngectomy, and improved survival in advanced laryngeal SCC. Health policy efforts should be directed towards improving early access to diagnosis and care.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Travel
/
Laryngeal Neoplasms
/
Squamous Cell Carcinoma of Head and Neck
/
Health Services Accessibility
/
Laryngectomy
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Determinantes_sociais_saude
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Surg Oncol
Year:
2021
Document type:
Article
Affiliation country: