Regionalizing Ovarian Cancer Cytoreduction to High-volume Centers and the Impact on Patient Travel in New York State

Overview

Journal Gynecol Oncol

Date 2024 Jan 23

PMID 38262237

Authors

Ryan M Kahn

Xiaoyue Ma

Sushmita Gordhandas

Effi Yeoshoua

Ryan J Ellis

Xiuling Zhang

Emeline M Aviki

Nadeem R Abu-Rustum

Ginger J Gardner

Yukio Sonoda

Oliver Zivanovic

Kara Long Roche

Elizabeth Jewell

Thomas Boerner

Dennis S Chi

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the theoretical impact of regionalizing cytoreductive surgery for ovarian cancer (OC) to high-volume facilities on patient travel.

Methods: We retrospectively identified patients with OC who underwent cytoreduction between 1/1/2004-12/31/2018 from the New York State Cancer Registry and Statewide Planning and Research Cooperative System. Hospitals were stratified by low-volume (<21 cytoreductive surgical procedures for OC annually) and high-volume centers (≥21 procedures annually). A simulation was performed; outcomes of interest were driving distance and time between the centroid of the patient's residence zip code and the treating facility zip code.

Results: Overall, 60,493 patients met inclusion criteria. Between 2004 and 2018, 210 facilities were performing cytoreductive surgery for OC in New York; 159 facilities (75.7%) met low-volume and 51 (24.3%) met high-volume criteria. Overall, 10,514 patients (17.4%) were treated at low-volume and 49,979 (82.6%) at high-volume facilities. In 2004, 78.2% of patients were treated at high-volume facilities, which increased to 84.6% in 2018 (P < .0001). Median travel distance and time for patients treated at high-volume centers was 12.2 miles (IQR, 5.6-25.5) and 23.0 min (IQR, 15.2-37.0), and 8.2 miles (IQR, 3.7-15.9) and 16.8 min (IQR, 12.4-26.0) for patients treated at low-volume centers. If cytoreductive surgery was centralized to high-volume centers, median distance and time traveled for patients originally treated at low-volume centers would be 11.2 miles (IQR, 3.8-32.3; P < .001) and 20.2 min (IQR, 13.6-43.0; P < .001).

Conclusions: Centralizing cytoreductive surgery for OC to high-volume centers in New York would increase patient travel burden by negligible amounts of distance and time for most patients.

References

Becerra A, Aquina C, Mohile S, Tejani M, Schymura M, Boscoe F . Variation in Delayed Time to Adjuvant Chemotherapy and Disease-Specific Survival in Stage III Colon Cancer Patients. Ann Surg Oncol. 2016; 24(6):1610-1617. DOI: 10.1245/s10434-016-5622-4. View

Aletti G, Gostout B, Podratz K, Cliby W . Ovarian cancer surgical resectability: relative impact of disease, patient status, and surgeon. Gynecol Oncol. 2005; 100(1):33-7. DOI: 10.1016/j.ygyno.2005.07.123. View

Marang-van de Mheen P, Dijs-Elsinga J, Otten W, Versluijs M, Smeets H, Vree R . The relative importance of quality of care information when choosing a hospital for surgical treatment: a hospital choice experiment. Med Decis Making. 2011; 31(6):816-27. DOI: 10.1177/0272989X10386799. View

Querleu D, Planchamp F, Chiva L, Fotopoulou C, Barton D, Cibula D . European Society of Gynaecologic Oncology Quality Indicators for Advanced Ovarian Cancer Surgery. Int J Gynecol Cancer. 2016; 26(7):1354-63. DOI: 10.1097/IGC.0000000000000767. View

Tseng J, Cowan R, Zhou Q, Iasonos A, Byrne M, Polcino T . Continuous improvement in primary Debulking surgery for advanced ovarian cancer: Do increased complete gross resection rates independently lead to increased progression-free and overall survival?. Gynecol Oncol. 2018; 151(1):24-31. PMC: 6247423. DOI: 10.1016/j.ygyno.2018.08.014. View

Justiniano C, Aquina C, Fleming F, Xu Z, Boscoe F, Schymura M . Hospital and surgeon variation in positive circumferential resection margin among rectal cancer patients. Am J Surg. 2019; 218(5):881-886. DOI: 10.1016/j.amjsurg.2019.02.029. View

Vernooij F, Heintz A, Coebergh J, Massuger L, Witteveen P, van der Graaf Y . Specialized and high-volume care leads to better outcomes of ovarian cancer treatment in the Netherlands. Gynecol Oncol. 2009; 112(3):455-61. DOI: 10.1016/j.ygyno.2008.11.011. View

Kumpulainen S, Sankila R, Leminen A, Kuoppala T, Komulainen M, Puistola U . The effect of hospital operative volume, residual tumor and first-line chemotherapy on survival of ovarian cancer - a prospective nation-wide study in Finland. Gynecol Oncol. 2009; 115(2):199-203. DOI: 10.1016/j.ygyno.2009.07.011. View

Chang S, Bristow R, Chi D, Cliby W . Role of aggressive surgical cytoreduction in advanced ovarian cancer. J Gynecol Oncol. 2015; 26(4):336-42. PMC: 4620371. DOI: 10.3802/jgo.2015.26.4.336. View

10.

Kahn R, McMinn E, Yeoshoua E, Boerner T, Zhou Q, Iasonos A . Intrathoracic surgery as part of primary cytoreduction for advanced ovarian cancer: Going to the next level - A Memorial Sloan Kettering Cancer Center study. Gynecol Oncol. 2023; 170:46-53. PMC: 10023324. DOI: 10.1016/j.ygyno.2022.12.023. View

11.

Fotopoulou C . Intrathoracic surgery as part of primary cytoreduction for advanced ovarian cancer: The evolution of a "pelvic" surgeon. Gynecol Oncol. 2023; 170:A1-A3. DOI: 10.1016/j.ygyno.2023.02.011. View

12.

Fago-Olsen C, Hogdall C, Kehlet H, Christensen I, Ottesen B . Centralized treatment of advanced stages of ovarian cancer improves survival: a nationwide Danish survey. Acta Obstet Gynecol Scand. 2011; 90(3):273-9. DOI: 10.1111/j.1600-0412.2010.01043.x. View

13.

Xu Z, Aquina C, Justiniano C, Becerra A, Boscoe F, Schymura M . Centralizing Rectal Cancer Surgery: What Is the Impact of Travel on Patients?. Dis Colon Rectum. 2020; 63(3):319-325. DOI: 10.1097/DCR.0000000000001581. View

14.

Finlayson S, Birkmeyer J, Tosteson A, Nease Jr R . Patient preferences for location of care: implications for regionalization. Med Care. 1999; 37(2):204-9. DOI: 10.1097/00005650-199902000-00010. View

15.

Yang A, Chimonas S, Bach P, Taylor D, Lipitz-Snyderman A . Critical Choices: What Information Do Patients Want When Selecting a Hospital for Cancer Surgery?. J Oncol Pract. 2018; 14(8):e505-e512. PMC: 6550060. DOI: 10.1200/JOP.17.00031. View

16.

Xu Z, Becerra A, Justiniano C, Boodry C, Aquina C, Swanger A . Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes. Dis Colon Rectum. 2017; 60(12):1250-1259. DOI: 10.1097/DCR.0000000000000924. View

17.

Bizzarri N, Dostalek L, van Lonkhuijzen L, Giannarelli D, Lopez A, Falconer H . Association of Hospital Surgical Volume With Survival in Early-Stage Cervical Cancer Treated With Radical Hysterectomy. Obstet Gynecol. 2023; 141(1):207-214. PMC: 10445691. DOI: 10.1097/AOG.0000000000005026. View

18.

Chi D, Eisenhauer E, Zivanovic O, Sonoda Y, Abu-Rustum N, Levine D . Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol. 2009; 114(1):26-31. DOI: 10.1016/j.ygyno.2009.03.018. View

19.

Fotopoulou C, Concin N, Planchamp F, Morice P, Vergote I, du Bois A . Quality indicators for advanced ovarian cancer surgery from the European Society of Gynaecological Oncology (ESGO): 2020 update. Int J Gynecol Cancer. 2020; 30(4):436-440. DOI: 10.1136/ijgc-2020-001248. View

20.

Olaitan A, Weeks J, Mocroft A, Smith J, Howe K, Murdoch J . The surgical management of women with ovarian cancer in the south west of England. Br J Cancer. 2001; 85(12):1824-30. PMC: 2364011. DOI: 10.1054/bjoc.2001.2196. View