Access to chemotherapy services by availability of local and visiting oncologists.
OBJECTIVE
Geographic disparities have raised important questions about factors related to treatment choice and travel time, which can affect access to cancer care.


METHODS
Iowa residents who received chemotherapy regardless of where they were diagnosed or treated were identified through the Iowa Cancer Registry (ICR), a member of the SEER program. Oncologists and their practice locations, including visiting consulting clinics (VCCs), were tracked through the Iowa Physician Information System. Oncologists, VCCs, and patients were mapped to hospital service areas (HSAs).


RESULTS
Between 2004 and 2010, 113,885 newly diagnosed invasive cancers were entered into ICR; among patients in whom these cancers were diagnosed, 31.6% received chemotherapy as a first course of treatment. During this period, 106 Iowa oncologists practiced in 14 cities, and 82 engaged in outreach to 85 VCCs in 77 rural communities. Of patients receiving chemotherapy, 63.0% resided in an HSA that had a local oncologist and traveled 21 minutes for treatment on average. In contrast, 29.3% of patients receiving chemotherapy resided in an HSA with a VCC, and 7.7% resided in an HSA with no oncology provider. These latter two groups of patients traveled 58 minutes on average to receive chemotherapy. Availability of oncologists and VCCs affected where patients received chemotherapy. The establishment of VCCs increased access to oncologists in rural communities and increased the rate that chemotherapy was administered in rural communities from 10% to 24%, a notable increase in local access.


CONCLUSIONS
Access to cancer care is dependent on the absolute number of providers, but it is also dependent on their geographic distribution.
University of Iowa, Iowa City, IA; Memorial Sloan-Kettering Cancer Center, New York, NY; Beth Israel Deaconess Medical Center, Boston, MA; Scripps Clinic, La Jolla, CA; and American Society of Clinical Oncology, Alexandria, VA.
Marcia M
MM
Ward
Fred
F
Ullrich
Kevin
K
Matthews
Gerard
G
Rushton
Roger
R
Tracy
Dean F
DF
Bajorin
Michael A
MA
Goldstein
Michael P
MP
Kosty
Suanna S
SS
Bruinooge
Amy
A
Hanley
Charles F
CF
Lynch
D000293:Adolescent; D000328:Adult; D000368:Aged; D001336:Automobiles; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007484:Iowa; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010820:Physicians / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors; D014195:Travel; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult