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Michael Tøstesen,1 Mette Nørgaard,2 Jan Maxwell Nørgaard,3 Bruno C Medeiros,4 Claus Werenberg Marcher,5 Ulrik Malthe Overgaard,6 Marianne Tang Severinsen,7 Claudia Schoellkopf,8 Lene Sofie Granfeldt Østgård1–31Department of Clinical Medicine, Holstebro Regional Hospital, Aarhus, Denmark; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 3Department of Hematology, Aarhus University Hospital, Aarhus, Denmark; 4Department of Hematology, Stanford University, School of Medicine, Stanford, CA, USA; 5Department of Hematology, Odense University Hospital, Odense, Denmark; 6Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark; 7Department of Hematology, Aalborg University Hospital, Aalborg, Denmark; 8Department of Hematology, Herlev University Hospital, Herlev, DenmarkCorrespondence: Lene Sofie Granfeldt ØstgårdDepartment of Hematology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, DenmarkTel +45 2 972 8127Email lenoestg@rm.dkBackground: Treatment of acute myeloid leukemia (AML) is widely centralized. Longer distances to a specialized treatment center may affect patients’ access to curative-intended treatment. Especially during outpatient treatment, distance may also affect survival.Methods and patients: The authors conducted a national population-based cohort study including all AML patients diagnosed in Denmark between 2000 and 2014. We investigated effects of distance (100) to the nearest specialized treatment facility on the probability of receiving intensive chemotherapy, HSCT, and achieving a complete remission (CR) using logistic regression analysis (odds ratios; ORs). For overall survival, we used Cox proportional hazards regression (hazard ratios [HRs]) and adjusted (a) for relevant baseline characteristics.Results: Of 2,992 patients (median age=68.5 years), 53% received intensive chemotherapy and 12% received low-dose chemotherapy outpatient regimens. The median distance to a specialized treatment center was 40 km (interquartile range=10–77 km). No impact of distance to specialized treatment centers was seen on the probability of receiving intensive chemotherapy (10–25 km, aOR=1.1 (CI=0.7–1.7), 25–50 km, aOR=1.1 (CI=0.7–1.7), 50–100 km, aOR=1.3 (CI=0.9–1.9), and >100 km, aOR=1.4 [CI=0.9–2.2]). Overall survival in patients regardless of therapy (100 km, aOR=1.0 [CI=0.9–1.2]), in intensive therapy patients, or in patients’ choice of post-remission was not affected by distance to specialized treatment center. Distance to a transplant center also did not affect the probability of HSCT or survival post-HSCT.Conclusion: In Denmark, distance to a specialized treatment facility offering remission-induction chemotherapy and HSCT does not negatively affect access to curative-indented therapy, treatment-response, or survival in AML patients.Keywords: hematology, allogeneic transplantation, socioeconomics, prognosis, epidemiology |
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