Impact of the distance between the patient's residence and the reference center on clinical and quality indicators of healthcare provided to women with gestational trophoblastic neoplasia in the State of Rio de Janeiro
DOI:
https://doi.org/10.5327/JBG-0368-1416-202313382Keywords:
gestational trophoblastic disease, drug therapy, neoplasm metastasisAbstract
Introduction: Gestational trophoblastic neoplasia is a rare and largely curable disease, even in chemoresistant and multimetastatic cases, especially if treated in reference centers. Objective: 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. Methods: Retrospective historical cohort study of patients with GTN followed at GTN-RC in the State of Rio de Janeiro, from January 1st, 2000, until December 31st, 2017. Results: A total of 462 cases of GTN treated at the Rio de Janeiro RC were evaluated. The median distance traveled between the GTN patient’s home and the RC was 50 km. When the distance between the patient's home and the GTN-RC ≥50 km, there was a significant association with more unfavorable outcomes, including a significant delay in starting chemotherapy (3 vs. 2 months, p<0.01), a higher occurrence of initiation of treatment outside the RC (10 versus 7%, p<0.01), treatment in disagreement with the criteria of the International Federation of Gynecology and Obstetrics — FIGO (7 vs. 2%), occurrence of metastatic disease at presentation (22 vs. 7%, p<0.01), FIGO score 7–12 (23 vs. 14%, p<0.01) and ≥ 13 (5 vs. 1%, p<0.01), higher occurrence of follow-up dropout during chemotherapy (6 vs. 2%, p<0.01), as well as a higher occurrence of chemoresistance (26 vs. 6%, p<0.01), higher number of patients who received an incomplete number of consolidation chemotherapy cycles (71 vs. 47%, p<0.01), higher occurrence of relapse (5.6 vs. 0.4%, p<0.01) and death from GTN (4.6 vs. 1.2, p<0.01), in relation to those residing < 50 km from the GTN-RC in question, respectively. Conclusions: The distance between the patient's home and the GTN-RC in the State of Rio de Janeiro is associated with unfavorable outcomes, including death from this disease.
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