A Tale of Two Cancers: Traveling to Treat Pancreatic and Thyroid Cancer

J Am Coll Surg. 2017 Jul;225(1):125-136.e6. doi: 10.1016/j.jamcollsurg.2017.02.017. Epub 2017 May 1.


Background: Patients diagnosed with a malignancy must decide whether to travel for care at an academic center or receive treatment at a nearby hospital. Here we examine differences in demographics, treatment, and outcomes of those traveling to academic centers for their care vs those not traveling, as well as compare travel for an aggressive vs indolent malignancy.

Study design: All patients with papillary thyroid carcinoma (PTC) or pancreatic ductal adenocarcinoma (PDAC) undergoing surgical resection and in the National Cancer Database were examined. Travel for care was abstracted from "crowfly" distance between patients' ZIP codes and treatment facility, region, county size, urban/metro/rural status, and facility type.

Results: In total, 105,677 patients with PTC and 22,983 patients with PDAC were analyzed. There were no survival differences by travel in the PTC group. Survival was improved for patients with PDAC traveling from urban/rural settings (hazard ratio = 0.89; 95% CI 0.82 to 0.96; p = 0.002). Patients traveling with PDAC were more likely to have a complete resection and lymph node dissection. Those traveling were less likely to receive chemotherapy or radiotherapy (all p < 0.001). Those traveling with PTC were older, more likely to be male, have Medicare insurance, and had a higher stage of disease (all p < 0.001). Rates of radioactive iodine were lower, American Thyroid Association guidelines were more likely followed, and lymph node dissection was more common for those traveling for care of their PTC (all p < 0.001).

Conclusions: There are improvements in both quality and survival for those traveling to academic centers for their cancer care. In the case of PTC, this difference in quality did not affect overall survival. In PDAC, however, differences in quality translated to a survival advantage.

MeSH terms

  • Academic Medical Centers
  • Adenocarcinoma / surgery*
  • Aged
  • Carcinoma, Pancreatic Ductal / pathology
  • Carcinoma, Pancreatic Ductal / therapy*
  • Carcinoma, Papillary / pathology
  • Carcinoma, Papillary / therapy*
  • Comorbidity
  • Female
  • Health Services Accessibility
  • Humans
  • Lymph Node Excision
  • Lymphatic Metastasis
  • Male
  • Neoplasm Staging
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy*
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / therapy*
  • Thyroidectomy
  • Travel*
  • Treatment Outcome