Effect of travel distance on outcomes of patients with malignant peritoneal mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Background

Malignant peritoneal mesothelioma (MPM) is a rare disease with a generally poor prognosis treated with systemic chemotherapy alone. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can offer improved overall survival in select patients. This study examined the effect of travel distance on oncologic outcomes in patients with MPM undergoing CRS-HIPEC.

Methods

The National Cancer Database (NCDB) was reviewed from 2006 to 2020. The primary variable was distance traveled to CRS-HIPEC facility (<50 miles versus ≥50 miles). Primary outcome was overall survival. Secondary outcomes examined 30- and 90-day post-surgical outcomes.

Results

Overall, 650 patients met inclusion criteria; 345 patients traveled < 50 miles and 305 patients traveled ≥ 50 miles. Rates of MPM were highest in the Northeast, Middle and South Atlantic regions. Patients traveling ≥50 miles were younger, had a lower median income, and were more likely to be privately insured and treated at an academic center. There was no difference in overall survival between groups (p=0.87). Secondary outcomes were comparable: 30-day survival was 98 % in both groups (p=0.9), 90-day survival was 93 % in both groups (p=0.9), 30-day readmission rate was 11 % in the shorter travel distance group versus 7 % (p=0.2). Hospital length of stay (LOS) was longer in the ≥50 miles group (9 vs 8 days; p=0.02).

Conclusions

Outcomes following CRS-HIPEC for MPM did not differ based upon distance traveled for treatment, though patients who travel ≥ 50 miles have an increased LOS. Regionalization of CRS-HIPEC for MPM does not result in worse oncologic or surgical outcomes.