Travel distance and its interaction with patient and hospital factors in pancreas cancer care

Am J Surg. 2021 Apr;221(4):819-825. doi: 10.1016/j.amjsurg.2020.08.023. Epub 2020 Aug 25.


Background: Although volume-outcome literature supports regionalization for complex procedures, travel may be burdensome. We assessed the relationship between overall survival and travel distance for patients undergoing pancreatic resection for adenocarcinoma.

Methods: We analyzed the Fall 2018 National Cancer Database Public Use File. We defined distance traveled as a categorical variable (<12.5 miles, 12.5-50mi, and >50mi). We analyzed overall survival (OS) as a function of distance traveled using the log rank test and Cox proportional hazards models; we estimated stratified models to assess for interaction between distance and other relevant covariates.

Results: In adjusted analysis of 39,089 patients, greater distance was associated with decreased OS (p = 0.0029). We found interactions between distance and center type, comorbidities, and age. Distance traveled was a negative factor for patients treated at low-volume academic centers (but not high-volume academic or non-academic centers). Additionally, distance traveled was a negative factor for OS in young, healthy patients but not geriatric, ill patients.

Conclusion: Traveling more than 12.5 miles for pancreatic resection was associated with worse OS. Prior to regionalization, evaluation of local resources may be necessary.

Keywords: Disparities; Health services research; Outcomes; Pancreatic cancer; Social determinants of health.

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / surgery*
  • Aged
  • Female
  • Health Services Accessibility*
  • Hospitals, High-Volume
  • Hospitals, Low-Volume
  • Humans
  • Male
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / surgery*
  • Retrospective Studies
  • Social Determinants of Health
  • Survival Rate
  • Travel*