Investigators evaluate impact of travel distance on radical cystectomy outcomes


“We wanted to look at, is there something to be said for delay in treatment or time to surgery?” says Randie White, MD.

In this video, Randie White, MD, discusses the background for the recent Urology Practice study, “Distance to Treatment with Radical Cystectomy in a Rural State: Long Car Rides, Equivalent Outcomes.” White is a urology resident at Maine Medical Center in Portland.


Please describe the background for this study.

Radical cystectomy is the most common treatment for muscle-invasive bladder cancer. It's a fairly complex procedure, it has a high morbidity and mortality rate, and it has a high 90-day readmission rate. As such, it tends to be performed at high-volume centers, and that's something known as regionalization of care. Because of this, patients tend to travel far distances for care. This is something that can impact access to care. We've seen a lot of studies that have showed that this transition between a referral center and a high-volume academic center can affect time to surgery. This is especially important for patients who have muscle-invasive bladder cancer, because patients who have greater than a 3-month delay between their diagnosis and time to surgery can lead to pathologic upstaging. We wanted to look at, is there something to be said for delay in treatment or time to surgery? And additionally, we wanted to look at, is there something with fragmentation of care or lack of coordination of care? And does this lead to worse outcomes? In Maine, specifically, we're the only academic center in this very large and rural state; we perform over 80% of the radical cystectomies in the state. We're also a very large and rural state, we have patients who are traveling upwards of 5 hours for care who live up in the northern part of the state. We also have a high rate of bladder cancer; we have the highest incidence of bladder cancer by state, and we wanted to look at what was the ability of our systemic processes in preventing fragmentation of care. So we wanted to evaluate the impact of travel distance on 90-day outcomes, readmission rates, and time to treatment.

This transcript was edited for clarity.

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