Association of Distance from Transplant center and Place of Residence on Outcomes after Allogeneic Hematopoietic Cell Transplantation.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 22, Issue 7, p.1319-23 (2016)

Abstract:

Regionalization of specialized health services can deliver high-quality care but may have an adverse impact on access and outcomes due to distance from the regional centers. In case of hematopoietic cell transplantation (HCT), the effect of increased distance from transplant center and rural/ urban residence is unclear due to conflicting results from the existing studies. We examined the association between distance from primary residence to the transplant center and rural vs. urban residence with clinical outcomes following allogeneic HCT in a large cohort of patients. Overall mortality (OM), non-relapse mortality (NRM) and relapse in all patients and those that survived for 200 days after HCT was assessed in 2849 patients who received their first allogeneic HCT between 2000 and 2010 at Fred Hutchinson Cancer Research Center (FHCRC) /Seattle Cancer Care Alliance (SCCA). Median distance from FHCRC was 263 miles (range 0 to 2740 miles), and 83% were urban residents. The association between distance and the hazard of OM varied according to conditioning intensity: myeloablative (MA) vs. non-myeloablative (NMA). Among MA patients, there was no evidence of an increased risk of mortality with increased distance, but NMA patients did show a suggestion of increased risk of mortality for some distances, although globally the difference was not statistically significant. In the subgroup of patients who survived till 200 days, there was no evidence that the risk of OM, relapse or NRM was increased with increasing distance. We did not find any association between longer distance from transplant center and urban/ rural residence and outcomes after MA HCT. In patients undergoing NMA transplants, this relationship and how it is influenced by factors such as age, payors and comorbidities needs to be further investigated.