title: Determinants of NCI Cancer Center attendance in Medicare patients with lung, breast, colorectal, or prostate cancer.
abstract: BACKGROUND
  Geographic access to NCI-Cancer Centers varies by region, race/ethnicity, and place of residence, but utilization of these specialized centers has not been examined at the national level in the U.S. This study identified determinants of NCI-Cancer Center attendance in Medicare cancer patients.
  
  
  METHODS
  SEER-Medicare (Surveillance Epidemiology and End Results) data were used to identify individuals with an incident cancer of the breast, lung, colon/rectum, or prostate from 1998-2002. NCI-Cancer Center attendance was determined based on utilization claims from 1998-2003. Demographic, clinical, and geographic factors were examined in multilevel models. We performed sensitivity analyses for the NCI-Cancer Center attendance definition.
  
  
  RESULTS
  Overall, 7.3% of this SEER-Medicare cohort (N = 211,048) attended an NCI-Cancer Center. Travel-time to the nearest NCI-Cancer Center was inversely related to attendance, showing 11% decreased likelihood of attendance for every 10 minutes of additional travel-time (OR = 0.89, 95%CI 0.88-0.90). Receiving predominantly generalist care prior to diagnosis was associated with a lower likelihood of attendance (OR = 0.79, 95%CI 0.77-0.82). The other factors associated with greater NCI-Cancer attendance were later stage at diagnosis, fewer comorbidities, and urban residence in conjunction with African-American race.
  
  
  CONCLUSIONS
  Attendance at NCI-Cancer Centers is low among Medicare beneficiaries, but is strongly influenced by proximity and general provider care prior to diagnosis. Other patient factors are predictive of NCI-Cancer Center attendance and may be important in better understanding cancer care utilization.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH, USA. Tracy.Onega@dartmouth.edu
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Duell
authors.forename: Xun
authors.initials: X
authors.lastname: Shi
authors.forename: Eugene
authors.initials: E
authors.lastname: Demidenko
authors.forename: David
authors.initials: D
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D054547:National Cancer Institute (U.S.) / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D014481:United States / Q000453:epidemiology