What factors influence minority use of National Cancer Institute-designated cancer centers?
BACKGROUND
National Cancer Institute (NCI) cancer centers provide high-quality care and are associated with better outcomes. However, racial and ethnic minority populations tend not to use these settings. The current study sought to understand what factors influence minority use of NCI cancer centers.


METHODS
A data set containing California Cancer Registry (CCR) data linked to patient discharge abstracts identified all patients with colorectal cancer (CRC) who were treated from 1996 through 2006. Multivariable models were generated to predict the use of NCI settings by race. Geographic proximity to an NCI center and patient sociodemographic and clinical characteristics were assessed.


RESULTS
Approximately 5% of all identified patients with CRC (n = 79,231) were treated in NCI settings. The median travel distance for treatment for all patients in all hospitals was ≤ 5 miles. A higher percentage of minorities lived near an NCI cancer center compared with whites. A baseline multivariable model predicting use showed a negative association between Hispanic ethnicity and NCI center use (odds ratio, 0.71; 95% confidence interval, 0.64-0.79). Asian/Pacific Islander patients were more likely to use NCI centers (odds ratio, 1.41; 95% confidence interval, 1.28-1.54). There was no difference in use noted among black patients. Increasing living distance from an NCI cancer center was found to be predictive of lower odds of use for all populations. Medicare and Medicaid insurance statuses were positively associated with NCI center use. Neighborhood-level education was found to be a more powerful predictor of NCI use than poverty or unemployment.


CONCLUSIONS
Select minority groups underuse NCI cancer centers for CRC treatment. Sociodemographic factors and proximity to NCI centers are important predictors of use. Interventions to address these factors may improve minority attendance to NCI cancer centers for care.
Section of Colon and Rectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
Lyen C
LC
Huang
Yifei
Y
Ma
Justine V
JV
Ngo
Kim F
KF
Rhoads
D000293:Adolescent; D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D015179:Colorectal Neoplasms / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D054547:National Cancer Institute (U.S.); D014481:United States
National Cancer Institute-designated cancer centers; access to care; colorectal cancer; health care disparities; insurance coverage; socioeconomic factors