Background: Hematopoietic cell transplant (HCT) recipients are at increased risk of disease-related distress and physical dysfunction. Increased driving distance between patient homes and HCT centers has been associated with worsened survival (Abou-Nassar et al, Biol Blood Marrow Transplant, 2012). We investigated whether increased driving distance was similarly associated with increased patient distress and physical dysfunction in HCT survivors.
Methods: We analyzed baseline data for HCT recipients enrolled in a multicenter survivorship study. Patients completed the Cancer and Treatment Distress (CTXD) and the Patient-Reported Outcomes Measurement Information System Physical Function 10a (PROMIS) survey instruments at enrollment. Based on a pre-specified cutoff of 500 current driving-distance miles from transplant center, patients were divided into standard or extremely-long distance groups.
CTXD scores and standardized PROMIS scores were compared using t tests to measure patient distress and physical function, respectively. Sub-analyses were performed based on current age, post-transplant interval, enrollment method (online or by mail), HCT type, patient-reported current GVHD status, HCT center region (Eastern, Midwestern, or Western US), gender, race / ethnicity, partner status, and annual income.
Results: N = 1143 patients were enrolled, of whom 85% (n = 966) were standard distance and 15% (n = 177) were extremely-long distance. 623 patients (55%) had received autologous HCTs while the remainder had received allogeneic HCTs. The extremely-long distance group was slightly younger (mean age 56 versus 58 years old), more likely to have undergone HCT at Western US centers, more likely to be non-white, and more likely to report annual incomes over $120K.
CTXD and PROMIS scores did not vary between the standard-distance and extremely-long distance groups. However, sub-analyses showed lower CTXD scores (lower distress) and higher PROMIS scores (better physical function) in the extremely-long distance group for patients who had received reduced-intensity conditioning (RIC) or with annual income over $120K.
Conclusions: In our multicenter retrospective analysis of over 1000 HCT recipients, we found no uniform relationship between driving distance and patient distress or physical dysfunction. Instead, extremely long driving distance was paradoxically associated with lower distress and physical dysfunction among higher-income or RIC-conditioned survivors. This may be related to underlying features of patients who pursue HCT at a distant transplant center. Study limitations include our inability to study HCT recipients who died prior to enrollment. Further research is needed to prospectively model the impact of driving distance on patient-related outcomes to better guide future interventions targeting distress and physical dysfunction among HCT survivors.
Source: Biology of Blood and Marrow Transplantation, 24(3), S257-S258.
Author: Banerjee, R., Yi, J. C., Majhail, N. S., Jim, H. S. L., Uberti, J., Whalen, V., . . . Syrjala, K. L. (2018).https://www.bbmt.org/article/S1083-8791(17)31077-7/fulltext