Objective: To explore the associations between travel distance, hospital volume, and outcomes following radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).
Method: The 2006 to 2013 National Cancer Database was queried to identify patients with MIBC who underwent RC. Multivariable regressions alternately including travel distance, hospital volume, and both in the models were used. Travel distances and hospital volumes were categorized by quartiles. Outcomes of interest were overall survival and quality-of-care indicators.
Result: A total of 6551 patients were included in the final cohort. When only travel distance or hospital volume was included in the multivariable regression model, fourth quartiles of both variables were associated with improved overall survival. When both travel distance and hospital volume were included in the model, only hospital volume was found to be associated with overall survival. Sensitivity analyses with both travel distance and hospital volume considered as continuous variables showed similar results. Patients who underwent RC in high-volume hospitals were more likely to receive neoadjuvant chemotherapy, have 10 or more lymph nodes removed, but also had higher odds of surgical delay (>3 months) in the full models adjusting for travel distance.
Conclusion: This National Cancer Database-based study suggests that the association between longer travel distance and improved overall survival (distance bias effect) after RC for MIBC is mainly mediated by higher hospital volume. The benefits of having RC at high-volume hospitals may outweigh the potential disadvantages of longer travel distance, which further supports the continued regionalization of RC and cancer care for MIBC.
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