Date of Conferral

2015

Degree

Ph.D.

School

Public Health

Advisor

Shanna L. Barnett

Abstract

Multiple Myeloma (MM) is a hematologic malignancy that accounts for approximately 1% of all adult cancers. This study investigated the impact of patient distance traveled to MM care sites, which was not considered in previous research on any disease-specific staging or prognostic schema despite evidence suggesting that distance impacts patient outcome. This study investigated the impact of patient distance from the site of care on survival outcomes using a group of 480 clinical trial participants. Andersenâ??s behavioral model of health services use functioned as the theoretical model for this study. The independent variable was patient travel distance, controlling for established measures of risk, including ISS Stage and Gene Expression Profiling based risk stratification. A Cox proportional hazard model was used to analyze time to progression and/or death outcome. Analysis revealed that patients who lived <120 miles from the site of care were 1.73 times more likely to experience cancer progression or death than those who lived â?¥ 121 miles. When controlling for ISS Stage and GEP risk, participants who lived <120 miles from the site of care were 1.67 times more likely to experience cancer progression or death than those who lived â?¥ 121 miles. Participants aged â?¥ 65 years who lived <120 miles were 1.88 times more likely to experience cancer progression and 1.75 times more likely to die than those who lived â?¥ 121 miles. Statistically significant results (p = <.05) were obtained for all PFS and OS outcomes with the exception of gender. This study promotes social change by improving the care of patients through science-based communications with healthcare providers and policy makers. Results from this trial may be readily applied to other more common hematologic malignancies.

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