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Primary Uterine Cancer in Maryland: Impact of Distance on Access to Surgical Care at High-Volume Hospitals

Gunderson, Camille C. MD*; Tergas, Ana I. MD, MPH; Fleury, Aimee C. MD, MPH; Diaz-Montes, Teresa P. MD, MPH; Giuntoli, Robert L. II MD

International Journal of Gynecological Cancer: September 2013 - Volume 23 - Issue 7 - p 1244–1251
doi: 10.1097/IGC.0b013e31829ea002
Uterine Cancer

Objective To evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland.

Methods The Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient’s zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals.

Results From 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (all P < 0.05). Patients who travel 50 miles or more to the treating hospital are more likely to have surgery at a HVH (odds ratio, 6.03; 95% confidence interval, 4.67–7.79) In contrast, patients, who reside ≥50 miles from a HVH, are less likely to have their surgery at an HVH. (odds ratio, 0.37; 95% confidence interval, 0.32–0.42).

Conclusion In Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

*Division of Gynecologic Oncology, University of Oklahoma Health Sciences Centers, Oklahoma City, OK; †The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD; and ‡Division of Gynecologic Oncology, Women’s Cancer Center of Nevada, Las Vegas, NV.

Address correspondence and reprint requests to Robert L. Giuntoli II, MD, Johns Hopkins Medicine, 600 N Wolfe St, Phipps 281, Baltimore, MD 21287. E-mail:

The authors declare no conflicts of interest.

Received March 26, 2013

Accepted May 17, 2013

© 2013 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.