title: Association Between Geographic Access to Cancer Care, Insurance, and Receipt of Chemotherapy: Geographic Distribution of Oncologists and Travel Distance.
abstract: OBJECTIVE
  Geographic access to care may be associated with receipt of chemotherapy but has not been fully examined. This study sought to evaluate the association between density of oncologists and travel distance and receipt of adjuvant chemotherapy for colon cancer within 90 days of colectomy.
  
  
  METHODS
  Patients in the National Cancer Data Base with stage III colon cancer, diagnosed between 2007 and 2010, and age 18 to 80 years were selected. Generalized estimating equation clustering by hospital service area was conducted to examine the association between geographic access and receipt of oncology services, controlling for patient sociodemographic and clinical characteristics.
  
  
  RESULTS
  Of 34,694 patients in the study cohort, 75.7% received adjuvant chemotherapy within 90 days of colectomy. Compared with travel distance less than 12.5 miles, patients who traveled 50 to 249 miles (odds ratio [OR], 0.87; P=.009) or ≥250 miles (OR, 0.36; P<.001) had decreased likelihood of receiving adjuvant chemotherapy. Density level of oncologists was not statistically associated with receipt of adjuvant chemotherapy (low v high density: OR, 0.98; P=.77). When stratifying analyses by insurance status, non-privately insured patients who resided in areas with low density of oncologists were less likely to receive adjuvant chemotherapy (OR, 0.85; P=.03).
  
  
  CONCLUSIONS
  Increased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with nonprivate insurance who resided in low-density oncologist areas were less likely to receive adjuvant chemotherapy. If these findings are validated prospectively, interventions to decrease geographic barriers may improve the timeliness and quality of colon cancer treatment.
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT. anna.lin@cancer.org.
authors: Chun Chieh
authors: CC
authors: Lin
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Suanna S
authors: SS
authors: Bruinooge
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: M Kelsey
authors: MK
authors: Kirkwood
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Christine
authors: C
authors: Olsen
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Ahmedin
authors: A
authors: Jemal
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Dean
authors: D
authors: Bajorin
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Sharon H
authors: SH
authors: Giordano
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Michael
authors: M
authors: Goldstein
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: B Ashleigh
authors: BA
authors: Guadagnolo
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Michael
authors: M
authors: Kosty
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Shane
authors: S
authors: Hopkins
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: James B
authors: JB
authors: Yu
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Anna
authors: A
authors: Arnone
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Amy
authors: A
authors: Hanley
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Stephanie
authors: S
authors: Stevens
authors: Chun Chieh Lin and Ahmedin Jemal, American Cancer Society, Atlanta, GA; Suanna S. Bruinooge, M. Kelsey Kirkwood, and Amy Hanley, American Society of Clinical Oncology, Alexandria; Anna Arnone and Stephanie Stevens, American Society for Radiation Oncology, Fairfax, VA; Christine Olsen, Massachusetts General Hospital; Michael Goldstein, Beth Israel Deaconess Medical Center, Boston, MA; Dean Bajorin, Memorial Sloan Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Sharon H. Giordano and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; Michael Kosty, Scripps Clinic, La Jolla, CA; Shane Hopkins, William R. Bliss Cancer Center, Ames, IA; and James B. Yu, Yale University School of Medicine, New Haven, CT.
authors: Dawn L
authors: DL
authors: Hershman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002391:Catchment Area, Health; D017024:Chemotherapy, Adjuvant; D016000:Cluster Analysis; D003082:Colectomy; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016013:Likelihood Functions; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D014195:Travel; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D000078329:Workforce; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents