Association between travel distance and overall survival among patients with adrenocortical carcinoma

Charles D. Logan*, Sara E.A. Nunnally, Catherine Valukas, Samantha Warwar, Joanna T. Swinarska, Frances T. Lee, David J. Bentrem, David D. Odell, Dina M. Elaraj, Cord Sturgeon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and Objectives: Regionalization of care is associated with improved perioperative outcomes after adrenalectomy. However, the relationship between travel distance and treatment of adrenocortical carcinoma (ACC) is unknown. We investigated the association between travel distance, treatment, and overall survival (OS) among patients with ACC. Methods: Patients diagnosed with ACC between 2004 and 2017 were identified with the National Cancer Database. Long distance was defined as the highest quintile of travel (≥42.2 miles). The likelihood of surgical management and adjuvant chemotherapy (AC) were determined. The association between travel distance, treatment, and OS was evaluated. Results: Of 3492 patients with ACC included, 2337 (66.9%) received surgery. Rural residents were more likely to travel long distances for surgery than metropolitan residents (65.8% vs. 15.5%, p < 0.001), and surgery was associated with improved OS (HR 0.43, 95% CI 0.34–0.54). Overall, 807 (23.1%) patients received AC with rates decreasing approximately 1% per 4-mile travel distance increase. Also, long distance travel was associated with worse OS among surgically treated patients (HR 1.21, 95% CI 1.05–1.40). Conclusions: Surgery was associated with improved overall survival for patients with ACC. However, increased travel distance was associated with lower likelihood to receive adjuvant chemotherapy and decreased overall survival.

Original languageEnglish (US)
Pages (from-to)749-763
Number of pages15
JournalJournal of surgical oncology
Issue number5
StateAccepted/In press - 2023
Externally publishedYes


  • adrenalectomy
  • rural population
  • travel

ASJC Scopus subject areas

  • Oncology
  • Surgery


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