Travelling to a High-volume Center Confers Improved Survival in Stage I Non-small Cell Lung Cancer

Abstract Background The association of hospital volume with outcomes has been assessed previously for patients with non-small cell lung cancer (NSCLC), but there is limited data on the cumulative effect of travel burden and hospital volume on treatment decisions and survival outcomes. We used the National Cancer Database to evaluate this relationship in early-stage NSCLC. Methods Outcomes of interest were compared between two propensity-matched groups with stage I NSCLC: patients in the bottom quartile of distance travelled who underwent surgery at low-volume centers (Local) and those in the top quartile of distance travelled who received surgery at high-volume centers (Distant). Outcomes included type of resection (anatomic or non-anatomic), time to resection ( Results We identified 3325 Local patients who travelled 2.3 miles [Interquartile range (IQR): 1.4-3.3] to centers that treated 10.5 (IQR: 6.5-16.5) stage I NSCLCs/year and 3361 Distant patients who travelled 40.0 miles (IQR: 29.1-63.4) to centers treating 56.9 (IQR: 40.1-84.7) stage I NSCLCs/year. Local patients were less likely to receive surgery Conclusions Patients travelling longer distances to high-volume centers receive better and more timely surgical care, leading to shorter hospital stays and improved survival outcomes. Regionalization of lung cancer care by improving travel support to larger treatment facilities may help improve early-stage NSCLC outcomes.