The National Comprehensive Cancer Network guidelines provide evidence-based consensus for optimal individual site- and stage-specific treatments. This is a cohort study of 11,121 late-stage oral cancer patients in the National Cancer Database from 2010 to 2016. We hypothesized that patient travel distance may affect treatment choices and impact outcome. We split travel distance (miles) into quartiles (D1–4) and assessed treatment choices, type of facility, and survival outcome in relation to distance traveled. Univariate and multivariate analyses addressed contributions of specific variables. White patients were most likely to travel farthest (D4) for treatment compared to Black patients (D1). Urban area patients traveled shorter distances than those from rural areas. Greater travel distance was associated with patients undergoing surgical-based therapies and treatment at academic centers. Patients in D1 had the lowest median survival of all distance quartiles. Surgery-based multimodality treatment (surgery and radiation) had a median survival significantly greater than for non-surgical therapy. Several factors including travel distance and treatment facility were associated with survival outcomes for late-stage oral cavity cancers. Consideration of these factors may help improve the outcome for this patient population.
美国国家综合癌症网络指南为各部位及分期的个体化最佳治疗提供了循证共识。本研究基于2010年至2016年美国国家癌症数据库中11,121例晚期口腔癌患者的队列数据，提出患者就医距离可能影响治疗选择及预后的假设。我们将就医距离（英里）按四分位数划分为D1-D4组，评估不同距离区间与治疗选择、医疗机构类型及生存结局的关联，并通过单变量与多变量分析探讨特定变量的影响。 结果显示：与黑人患者（D1组）相比，白人患者更倾向于远距离（D4组）就医；城市患者就医距离短于农村患者；更长的就医距离与接受手术为主的治疗方案及在学术医疗中心就诊相关。D1组患者在所有距离分组中位生存期最短，以手术为基础的多模式治疗（手术联合放疗）中位生存期显著优于非手术治疗。研究表明，就医距离和治疗机构类型等多种因素与晚期口腔癌患者的生存结局相关，关注这些因素可能有助于改善该患者群体的预后。
肿瘤(癌症)患者之家