Distance From Residence to Hospital and Mortality Among Patients Diagnosed With and Receiving Surgical Treatment for Late‐Stage Epithelial Ovarian Cancer in the United States

Aims In patients diagnosed with advanced stage ovarian cancer, the distance from their residence to the treating facility has often been interpreted in a linear context, where patients who live greater distances experience higher mortality. Due to recent conflicting evidence and greater area‐level deprivation in neighborhoods surrounding cancer facilities, we hypothesized a nonlinear relationship between distance to the treating hospital and overall mortality in women with advanced stage ovarian cancer. Methods We used the National Cancer Database and included women ≥ 18 years with Stage III or IV ovarian cancer who underwent surgical treatment of the primary site from 2010 to 2021. The primary outcome was overall mortality with distance (km) from the patient's residence to the treating facility serving as the primary exposure. Chi‐squared and Kruskal–Wallis tests were used to compare study variables by quartiles of distance. A survival analysis was performed using Kaplan–Meier curves with log‐rank tests and Cox proportional hazard regression with restricted cubic spline (RCS) specification to assess the nonlinear association. Predicted one‐, three‐, and five‐year survival were plotted by distance according to the final model. Results Our final analytic sample had 39 948 patients with unadjusted one‐, three‐, and five‐year mortality rates at 9%, 16%, and 21% respectively, with no statistical difference in overall mortality between distance quartiles ( p = 0.282). On multivariable regression, with RCS transformations in the model, mortality did not significantly differ by distance. Conclusions The nonlinear interpretation of distance did not yield any significant difference in overall mortality, and 1‐, 3‐, and 5‐year mortality.