Does distance to the hospital affect the course of treatment and follow-up for children with Acute Lymphoblastic Leukemia?

Abstract

Purpose: Centralization of specialized healthcare including treatment of children with acute lymphoblastic leukemia (ALL) has increased in high-income countries. We aimed to clarify whether the distance to the hospital for children with ALL affects the course of treatment regarding the number and duration of hospitalizations, outpatient clinic visits, missed appointments in the outpatient clinic, the duration of follow-up, or survival.

Methods: We performed a retrospective cohort study of children diagnosed with ALL aged 0-14 at Aalborg University Hospital from 1996 to 2018. Data was collected through registries and medical records. Comparisons of cancer- and sociodemographic characteristics in children with long versus short distance were made, divided at 42 km. Outcome variables were assessed by correlation and regression analyses. We compared overall survival using Kaplan-Meier.

Results: The cohort consisted of 95 children. Cancer- and sociodemographic characteristics of the children with long versus short distance were similar, though the children with long distance were older and had less infections during treatment. There was no significant difference between the two groups regarding the number of hospitalizations, outpatient clinic visits, missed appointments, the duration of follow-up, or survival. Though, the summarized length of hospitalization was shorter for the group with long distance, when adjusting for age (-23 days (95% CI -45;-1)).

Conclusion: No significant differences between the course of treatment and follow-up for children with long and short distance to the hospital was revealed, except for a shorter summarized length of hospitalization for children with long distance.