Impact of nationwide centralization of oesophageal, gastric, and pancreatic surgery on travel distance and experienced burden in the Netherlands

J. C. H. B. M. Luijten, G. A. P. Nieuwenhuijzen, M. N. Sosef, I. H. J. T. de Hingh, C. Rosman, J. P. Ruurda, P. van Duijvendijk, J. Heisterkamp, W. O. de Steur, H. W. M. van Laarhoven, M. G. Besselink, B. Groot Koerkamp, H. C. van Santvoort, V. E. P. Lemmens, P. A. J. Vissers

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)

Abstract

Background: This study aims to assess the impact of nationwide centralization of surgery on travel distance and travel burden among patients with oesophageal, gastric, and pancreatic cancer according to age in the Netherlands. As centralization of care increases to improve postoperative outcomes, travel distance and experienced burden might increase.Materials and methods: All patients who underwent surgery between 2006 and 2017 for oesophageal, gastric and pancreatic cancer in the Netherlands were included. Travel distance between patient's home address and hospital of surgery in kilometres was calculated. Questionnaires were used to assess experienced travel burden in a subpopulation (n = 239). Multivariable ordinal logistic regression models were constructed to identify predictors for longer travel distance.Results: Over 23,838 patients were included, in whom median travel distance for surgical care increased for oesophageal cancer (n = 9217) from 18 to 28 km, for gastric cancer (n = 6743) from 9 to 26 km, and for pancreatic cancer (n = 7878) from 18 to 25 km (all p < 0.0001). Multivariable analyses showed an increase in travel distance for all cancer types over time. In general, patients experienced a physical and social burden, and higher financial costs, due to traveling extra kilometres. Patients aged >70 years travelled less often independently (56% versus 68%), as compared to patients aged <= 70 years.Conclusion: With nationwide centralization, travel distance increased for patients undergoing oesophageal, gastric, and pancreatic cancer surgery. Younger patients travelled longer distances and experienced a lower travel burden, as compared to elderly patients. Nevertheless, on a global scale, travel distances in the Netherlands remain limited. (C) 2021 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Original languageEnglish
Pages (from-to)348-355
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume48
Issue number2
DOIs
Publication statusPublished - Feb 2022

Bibliographical note

Funding:
This study was funded by the Dutch Cancer Society under
project number IKZ2012-5714. The funding source had no
involvement with the study design, in the writing of the paper and
in the decision to submit the article for publication.

Publisher Copyright: © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology.

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