title: Effects of distance to care and rural or urban residence on receipt of radiation therapy among North Carolina Medicare enrollees with breast cancer.
abstract: BACKGROUND
  Distance to oncology service providers and rurality may affect receipt of guideline-recommended radiation therapy (RT), but the extent to which these factors affect the care of Medicare-insured patients is unknown.
  
  
  METHODS
  Using cancer registry data linked to Medicare claims from the Integrated Cancer Information and Surveillance System (ICISS), we identified all women aged 65 years or older who were diagnosed with stage I, II, or III breast cancer from 2003 through 2005, who had Medicare claims through 2006, and who were clinically eligible for RT. We geocoded the address of each RT service provider's practice location and calculated the travel distance from each patient's residential address to the nearest RT provider. We used ZIP codes to classify each patient's residence as rural or urban according to rural- urban commuting area codes. We used generalized estimating equations models with county-level clustering and interaction terms between distance categories and rural-urban status to estimate the effect of distance to care and rural-urban status on receipt of RT.
  
  
  RESULTS
  In urban areas, increasing distance to the nearest RT provider was associated with a lower likelihood of receiving RT (odds ratio [OR] = 0.54; 95% confidence interval [CI], 0.30-0.97) for those living more than 20 miles from the nearest RT provider compared with those living less than 10 miles away. In rural areas, those living within 10-20 miles of the nearest RT provider were more likely to receive RT than those living less than 10 miles away (OR = 1.73; 95% CI, 1.08-2.76).
  
  
  CONCLUSIONS
  Results may not be generalizable to areas outside North Carolina or to non-Medicare populations.
  
  
  CONCLUSIONS
  Coordinated outreach programs targeted differently to rural and urban patients may be necessary to improve the quality of oncology care.
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. stephanie_wheeler@unc.edu.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Tzy-Mey
authors.initials: TM
authors.lastname: Kuo
authors.affiliation: Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Durham
authors.affiliation: Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Frizzelle
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Division of Hematology/Oncology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Reeder-Hayes
authors.affiliation: Integrated Cancer Information and Surveillance System (ICISS), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Meyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D006278:Medicare; D009657:North Carolina; D016017:Odds Ratio; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data