#LCSM Chat Topic 2019-02-07: Is it worth the drive?

Unfortunately, you just got diagnosed with cancer.  You and your family are desperately trying to figure out where to go and which doctor to see.  But how far are you willing to go?  Can you be more confident in your diagnosis, decrease your complications, and improve your chances of survival if you drive a little farther, past your local hospital, to a specialized center that treats a higher volume of cancer patients?  What would it take for you, the patient, to go that extra distance?

Seminal surgical studies have described a “volume outcome” effect, suggesting that cancer patients operated on at high volume centers are less likely to die in the hospital.  Recently, evidence was also published which suggested that stage IV lung cancer patients are more likely to survive when treated at academic versus community centers in the United States.  But how solid are these findings?  Are they clouded by selection bias and statistical flaws, in which the patients who travel for care are actually healthier, more motivated, and with better insurance and prognostic factors?  Although regionalization of complex cancer care (which is already mandated in some countries) may be appealing, we have to take potential patient barriers such as time away from work and family, costs of and ability to travel, insurance restrictions and other socioeconomic factors into account.  Failing to do so, would decrease access to care for patients with limited ability to travel.

Please join moderator Dr. Brendon Stiles (@BrendonStilesMD) at 8PM Thursday night, February 7, 2019, for this important discussion, one which affects almost every cancer patient and doctor.  We will cover the following topics:

  • T1: Do you travel far for cancer care?  If so, why?
  • T2: Is there data supporting the concept that surgery/oncology/radiation oncology results are better at high volume, specialty centers?
  • T3:  What are the downsides of and obstacles to traveling for your cancer care?
  • T4:  How can we best coordinate care between community and high volume regional centers?
  • T5:  Are there resources that exist to help patients educate themselves, get second opinions, or even facilitate travel for cancer care?

Please remember to include #LCSM in ALL your tweets so the other chat participants can see them. If you need a refresher on how to participate, read our primer on participating in the chat . Note that some tweetchat apps (like tchat.io) will not display tweets longer than 140 characters.  We look forward to the discussion.


Here is further reading on the topic:

Survival Comparison in Patients with Stage IV Lung Cancer in Academic versus Community Centers in the United States (Journal of Thoracic Oncology, Dec 2018)

How Far Would You Drive to Increase Your Chances of Cancer Survival? (Op-Med, Feb 2019)

Lung Cancer Surgery Patients May Reap Benefits of Larger, More Centralized Hospitals (Society of Thoracic Surgeons, Jan 2019)

Motivators, Barriers, and Facilitators to Traveling to the Safest Hospitals in the United States for Complex Cancer Surgery (JAMA Network, Nov 2018)


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