February 23, 2022
3 min read through
Adolescent and younger grownup patients with central anxious program tumors who lived farther from the reporting healthcare facility had a lower hazard for death than those people who lived nearer, in accordance to examine results published in Journal of Neuro-Oncology.
The reason, scientists wrote, could be that individuals touring from farther away obtain cure at increased-volume amenities with extra expertise managing CNS tumors. In addition, not all individual groups benefited equally, according to Kimberly J. Johnson, MD, PhD, affiliate professor and most cancers epidemiologist at Brown University at Washington University in St. Louis.
“We discovered a larger survival advantage in association with length to the reporting clinic for individuals with small-quality astrocytic tumors and ependymomas than other tumors, non-Hispanic white persons vs. non-Hispanic Black and Hispanic people, and people with residences at diagnosis or first treatment in greater-profits parts,” Johnson told Healio. “This looks to indicate that individuals with a lot more resources may possibly be in a position to journey farther to facilities with additional skills. This, in change, may impact survival results.”
Johnson and colleagues pursued the exploration mainly because they identified an affiliation of residing from the reporting clinic with improved survival among clients with CNS tumors in contrast to shorter survival for other tumor forms. and they wanted to check out the affiliation in additional depth.
Researchers gathered info from the Nationwide Cancer Databases on adolescents and younger grownups (AYAs) aged 15 to 39 decades identified with most cancers from 2010 to 2014. The survival examination provided 9,335 AYAs (56.1% male 72.7% non-Hispanic white 49.2% aged 30-39 several years) diagnosed with CNS and other intracranial and intraspinal neoplasms.
Johnson and colleagues categorised the people into three types, depending on the length between the patient’s location of residence and where by they obtained either their analysis or to start with treatment method: small ( 12.5 miles n = 4,007), intermediate (> 12.5 and < 50 miles n = 3,215), and long ( 50 miles n = 2,113). They used Cox proportional hazard regression models for analyses.
After adjustment for age, sex, race/ethnicity and ZIP code-level education and income, results showed AYAs with CNS tumors who lived farther from the reporting hospital had a reduced risk for death than those who lived shorter distances (intermediate vs. short distance, HR = 1.06 95% CI, 0.96-1.17 long vs. short distance, HR = 0.82 95% CI 0.73-0.93). The association of long vs. short distance attenuated after researchers adjusted for facility volume of patients with CNS tumors (HR = 0.92 95% CI, 0.81-1.04).
“Why CNS tumors are somewhat different from other tumor types is a little surprising, but perhaps it is due to the very specialized neuro-oncology expertise needed to successfully treat these tumors,” Johnson said. “I found it notable that the survival benefit associated with longer distances only applied to non-Hispanic white patients.”
Johnson and colleagues reported a significant association between distance from the reporting facility and survival based on race/ethnicity (P = .0002) and income (P = .02).
In two models — one adjusted for age, sex, education and income quartile and another adjusted for facility CNS tumor volume — they observed lower HRs for long vs. short residential distance to reporting facility among non-Hispanic white AYAs (model 1, HR = 0.76 95% CI, 0.66-0.87 model 2, HR = 0.86 95% CI, 0.74-1) than among non-Hispanic Black AYAs (model 1, HR = 0.94 95% CI, 0.67-1.31 model 2, HR = 0.99 95% CI, 0.7-1.4). Additionally, AYAs living in areas with the highest median ZIP code-level income had the lowest HR in association with long vs. short residential distance to reporting hospital in both models (model 1, HR = 0.71 95% CI, 0.53-0.94 model 2, HR = 0.8 95% CI, 0.59-1.09).
“More research is needed to understand the barriers to access in these patients to develop strategies that address these disparities,” Johnson said. “Barriers may be related to direct and indirect costs associated with care, such as living and traveling expenses, time off work, and not being able to care for family members.”
Johnson and colleagues are continuing the research to examine how the characteristics of facilities may be impacting outcomes in patients with CNS tumors.
For more information:
Kimberly J. Johnson, MD, PhD, can be reached at Brown School, Washington University in St. Louis, Campus Box 1196, 1 Brookings Drive, St. Louis, MO 63130 email: [email protected].