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Interaction Between Travel Distance and Hospital Volume for Treatment of Extremity Soft Tissue Sarcoma: Is it worth the drive?
*Roberto J Vidri1, Chandrajit P Raut2, Timothy L Fitzgerald3
1St. Mary's Regional Medical Center, Lewiston, ME;2Brigham and Women's Hospital, Boston, MA;3Maine Medical Center, Portland, ME

Objective: Understand the effects of travel distance to treatment center on clinical outcomes and quality measures for extremity soft tissue sarcoma.
Design: Retrospective cohort study using NCDB. Travel distance (TD) and hospital volume (VOL) were categorized into quartiles. Alternating statistical models and coarsened exact matching were used for analysis.
Setting: Data from CoC-accredited hospitals in the United States.
Patients: Adult individuals diagnosed between 2004 and 2015 with Stage I, II, and III extremity soft-tissue sarcoma (ICD-10: C49.1 and C49.2) with selected histology.
Intervention: None.
Main Outcome Measures: Overall survival, rate of amputation, adequacy of surgical resection, hospital length of stay, and time to definitive therapy.
Results: 1,035 hospitals contributed 11,979 cases. Median and maximum VOL were 5 (IQR 2-12) and 45 cases/year, respectively. VOL quartiles were “low volume” (LV) (892 hospitals, <3 cases/yr), “intermediate low volume” (ILV) (89, 3-5 cases/yr), “intermediate high volume” (IHV) (39, 6-12 cases/yr), and “high volume” (HV) (15, >12 cases/yr). TD quartiles corresponded to: “short travel” (ST) (<8 mi), “intermediate short travel” (IST) (8-17 mi), “intermediate long travel” (ILT) (18-49 mi), and “long travel” (LT) (>50 mi). VOL, but not TD is associated with improved survival [HR 0.65 (CI 0.52-0.83)] and rate of R0 resection [1.87 (CI 1.4-2.5)]; but, have no effect on amputation rates. No correlation was identified with hospital length of stay or delay of definitive treatment. Comparison of patients in LT/HV vs. ST/LV demonstrate similar results.
Conclusions: For extremity soft tissue sarcomas, hospital volume and not distance traveled to treatment facility is associated with increased overall survival and rate of R0 resection. Despite the inconveniences of increased travel distances, patients may benefit from treatment at expert sarcoma centers.­


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