The impact of the distance traveled between residence and gestational trophoblastic neoplasia reference center and clinical outcomes in Brazilian women

• Published in: Gynecologic oncology Vol. 176; pp. 130 - 138
• Main Authors: Braga, Antonio, Lopes, Renata, Campos, Vanessa, Freitas, Fernanda, Maestá, Izildinha, Sun, Sue Yazaki, Pedrotti, Luana Giongo, Bessel, Marina, de Sousa, Christiani Bisinoto, Leal, Elaine, Yela, Daniela, Uberti, Elza, Madi, José Mauro, Viggiano, Mauricio, Junior, Joffre Amim, Filho, Jorge Rezende, Elias, Kevin M., Horowitz, Neil S., Berkowitz, Ross S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2023
• Subjects: Chemotherapy; Gestational trophoblastic disease; Gestational trophoblastic neoplasia; Metastasis; Referral center; Travel distance; Chemotherapy; Metastasis; Travel distance; Gestational trophoblastic neoplasia; Referral center; Gestational trophoblastic disease
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2023.07.012

To relate the distance traveled from the patient's residence to the gestational trophoblastic neoplasia (GTN) reference center (RC) and the occurrence of unfavorable clinical outcomes, as well as to estimate the possible association between this distance and the risk of metastatic disease at presentation, the need for multiagent chemotherapy to achieve remission and loss to follow-up before remission.
Retrospective historical cohort study of patients with GTN followed at 8 Brazilian GTN-RC, from January 1st, 2000 - December 31st, 2017.
Evaluating 1055 cases of GTN, and using a receiver operating characteristic curve, we found a distance of 56 km (km) from the residence to the GTN-RC (sensitivity = 0.57, specificity = 0.61) best predicted the occurrence of at least one of the following outcomes: occurrence of metastatic disease, need for multiagent chemotherapy to achieve remission, or loss to follow-up during chemotherapy. Multivariate logistic regression adjusted by age, ethnicity, marital status and the reference center location showed that when the distance between residence and GTN-RC was ≥56 km, there was an increase in the occurrence of metastatic disease (relative risk - RR:3.27; 95%CI:2.20–4.85), need for multiagent chemotherapy (RR:1.36; 95%CI:1.05–1.76), loss to follow-up during chemotherapy (RR:4.52; 95CI:1.93–10.63), occurrence of chemoresistance (RR:4.61; 95%CI:3.07–6.93), relapse (RR:10.27; 95%CI:3.08–34.28) and death due to GTN (RR:3.62; 95%CI:1.51–8.67).
The distance between the patient's residence and the GTN-RC is a risk factor for unfavorable outcomes, including death from this disease. It is crucial to guarantee these patients get prompt access to the GTN-RC and receive follow-up support.
•The distance between the patient's residence and GTN reference center (RC) is a risk factor for unfavorable outcomes.•Living ≥56 km from the RC is associated with metastases, need for multiagent chemotherapy and loss to follow-up.•Patients living long distances (≥56 km) for GTN-RC need special supportive care to facilitate optimal treatment and outcome.