Where do patients with cancer in Iowa receive radiation therapy?
OBJECTIVE
Multiple studies have shown survival benefits in patients with cancer treated with radiation therapy, but access to treatment facilities has been found to limit its use. This study was undertaken to examine access issues in Iowa and determine a methodology for conducting a similar national analysis.


METHODS
All Iowa residents who received radiation therapy regardless of where they were diagnosed or treated were identified through the Iowa Cancer Registry (ICR). Radiation oncologists were identified through the Iowa Physician Information System (IPIS). Radiation facilities were identified through IPIS and classified using the Commission on Cancer accreditation standard.


RESULTS
Between 2004 and 2010, 113,885 invasive cancers in 106,603 patients, 28.5% of whom received radiation treatment, were entered in ICR. Mean and median travel times were 25.8 and 20.1 minutes, respectively, to the nearest facility but 42.4 and 29.1 minutes, respectively, to the patient's chosen treatment facility. Multivariable analysis predicting travel time showed significant relationships for disease site, age, residence location, and facility category. Residents of small and isolated rural towns traveled nearly 3× longer than urban residents to receive radiation therapy, as did patients using certain categories of facilities.


CONCLUSIONS
Half of Iowa patients could reach their nearest facility in 20 minutes, but instead, they traveled 30 minutes on average to receive treatment. The findings identified certain groups of patients with cancer who chose more distant facilities. However, other groups of patients with cancer, namely those residing in rural areas, had less choice, and some had to travel considerably farther to radiation facilities than urban patients.
University of Iowa, Iowa City, IA; Beth Israel Deaconess Medical Center, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Scripps Clinic, La Jolla, CA; American Society of Clinical Oncology, Alexandria, VA; and West Virginia University School of Medicine, Morgantown, WV.
Marcia M
MM
Ward
Fred
F
Ullrich
Kevin
K
Matthews
Gerard
G
Rushton
Roger
R
Tracy
Michael A
MA
Goldstein
Dean F
DF
Bajorin
Michael P
MP
Kosty
Suanna S
SS
Bruinooge
Amy
A
Hanley
Geraldine M
GM
Jacobson
Charles F
CF
Lynch
D000293:Adolescent; D000328:Adult; D000368:Aged; D001336:Automobiles; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007484:Iowa; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000532:radiotherapy*; D012042:Registries / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D018426:SEER Program / Q000706:statistics & numerical data; D013997:Time Factors; D014195:Travel; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult