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Travel Distance as a Barrier to Receipt of Adjuvant Radiation Therapy After Radical Prostatectomy.

Abstract Following radical prostatectomy (RP), adjuvant radiation therapy (RT) decreases biochemical recurrence and potentially improves metastasis-free and overall survival for patients with high-risk pathologic features. Since adjuvant RT typically occurs daily over several weeks, the logistical challenges of extensive traveling may be a significant barrier to its use. We examined the association between distance to treatment facility and use of adjuvant RT.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title american journal of clinical oncology
Publication Year Start




PMID- 29045266
OWN - NLM
STAT- Publisher
LR  - 20171018
IS  - 1537-453X (Electronic)
IS  - 0277-3732 (Linking)
DP  - 2017 Oct 17
TI  - Travel Distance as a Barrier to Receipt of Adjuvant Radiation Therapy After
      Radical Prostatectomy.
LID - 10.1097/COC.0000000000000410 [doi]
AB  - OBJECTIVES: Following radical prostatectomy (RP), adjuvant radiation therapy (RT)
      decreases biochemical recurrence and potentially improves metastasis-free and
      overall survival for patients with high-risk pathologic features. Since adjuvant 
      RT typically occurs daily over several weeks, the logistical challenges of
      extensive traveling may be a significant barrier to its use. We examined the
      association between distance to treatment facility and use of adjuvant RT.
      MATERIALS AND METHODS: We identified 97,568 patients in the National Cancer
      Database diagnosed from 2004 through 2011 with cT1-4N0-xM0-x prostate cancer and 
      found to have high-risk pathologic features (pT3-4 stage and/or positive surgical
      margins) at RP. Multivariable logistic regression adjusting for sociodemographic 
      and clinicopathologic factors was used to examine the association between travel 
      distance and receipt of adjuvant RT, defined as radiotherapy initiated within 12 
      months after RP. RESULTS: Overall, 10.6% (10,346) of the study cohort received
      adjuvant RT. On multivariable analysis, increasing travel distance was
      significantly associated with decreased use of adjuvant RT, with adjusted odds
      ratios of 1.0 (reference), 0.67, 0.46, 0.39, and 0.32 (all P<0.001) and
      prevalence of use at 12.6%, 8.8%, 6.3%, 4.9%, and 3.7% for patients living
      </=25.0, 25.1 to 50.0, 50.1 to 75.0, 75.1 to 100.0, and >100.0 miles away,
      respectively. CONCLUSIONS: Increasing travel distance was strongly associated
      with decreased use of adjuvant RT in this national cohort of postprostatectomy
      patients with high-risk pathologic features. These results strongly suggest that 
      the logistical challenges of extensive travel are a significant barrier to the
      use of adjuvant RT. Efforts aimed at improving access to radiotherapy and
      reducing treatment time are urgently needed.
FAU - Yang, David D
AU  - Yang DD
AD  - *Harvard Medical School daggerHarvard Radiation Oncology Program double
      daggerDepartment of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber 
      Cancer Institute, Boston, MA.
FAU - Muralidhar, Vinayak
AU  - Muralidhar V
FAU - Mahal, Brandon A
AU  - Mahal BA
FAU - Beard, Clair J
AU  - Beard CJ
FAU - Mouw, Kent W
AU  - Mouw KW
FAU - Martin, Neil E
AU  - Martin NE
FAU - Orio, Peter F 3rd
AU  - Orio PF 3rd
FAU - King, Martin T
AU  - King MT
FAU - Nguyen, Paul L
AU  - Nguyen PL
LA  - eng
PT  - Journal Article
DEP - 20171017
PL  - United States
TA  - Am J Clin Oncol
JT  - American journal of clinical oncology
JID - 8207754
EDAT- 2017/10/19 06:00
MHDA- 2017/10/19 06:00
CRDT- 2017/10/19 06:00
PHST- 2017/10/19 06:00 [entrez]
PHST- 2017/10/19 06:00 [pubmed]
PHST- 2017/10/19 06:00 [medline]
AID - 10.1097/COC.0000000000000410 [doi]
PST - aheadofprint
SO  - Am J Clin Oncol. 2017 Oct 17. doi: 10.1097/COC.0000000000000410.