title: Association Between Geographic Access to Cancer Care and Receipt of Radiation Therapy for Rectal Cancer.
abstract: OBJECTIVE
  Trimodality therapy (chemoradiation and surgery) is the standard of care for stage II/III rectal cancer but nearly one third of patients do not receive radiation therapy (RT). We examined the relationship between the density of radiation oncologists and the travel distance to receipt of RT.
  
  
  METHODS
  A retrospective study based on the National Cancer Data Base identified 26,845 patients aged 18 to 80 years with stage II/III rectal cancer diagnosed from 2007 to 2010. Radiation oncologists were identified through the Physician Compare dataset. Generalized estimating equations clustering by hospital service area was used to examine the association between geographic access and receipt of RT, controlling for patient sociodemographic and clinical characteristics.
  
  
  RESULTS
  Of the 26,845 patients, 70% received RT within 180 days of diagnosis or within 90 days of surgery. Compared with a travel distance of <12.5 miles, patients diagnosed at a reporting facility who traveled ≥50 miles had a decreased likelihood of receipt of RT (50-249 miles, adjusted odds ratio 0.75, P<.001; ≥250 miles, adjusted odds ratio 0.46; P=.002), all else being equal. The density level of radiation oncologists was not significantly associated with the receipt of RT. Patients who were female, nonwhite, and aged ≥50 years and had comorbidities were less likely to receive RT (P<.05). Patients who were uninsured but self-paid for their medical services, initially diagnosed elsewhere but treated at a reporting facility, and resided in Midwest had an increased the likelihood of receipt of RT (P<.05).
  
  
  CONCLUSIONS
  An increased travel burden was associated with a decreased likelihood of receiving RT for patients with stage II/III rectal cancer, all else being equal; however, radiation oncologist density was not. Further research of geographic access and establishing transportation assistance programs or lodging services for patients with an unmet need might help decrease geographic barriers and improve the quality of rectal cancer care.
authors.affiliation: American Cancer Society, Atlanta, Georgia. Electronic address: anna.lin@cancer.org.
authors.forename: Chun Chieh
authors.initials: CC
authors.lastname: Lin
authors.affiliation: American Society of Clinical Oncology, Alexandria, Virginia.
authors.forename: Suanna S
authors.initials: SS
authors.lastname: Bruinooge
authors.affiliation: American Society of Clinical Oncology, Alexandria, Virginia.
authors.forename: M Kelsey
authors.initials: MK
authors.lastname: Kirkwood
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.affiliation: American Cancer Society, Atlanta, Georgia.
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
authors.affiliation: MD Anderson Cancer Center, Houston, Texas.
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.affiliation: William R. Bliss Cancer Center, Ames, Iowa.
authors.forename: Shane
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Goldstein
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Dean
authors.initials: D
authors.lastname: Bajorin
authors.affiliation: MD Anderson Cancer Center, Houston, Texas.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: Scripps Clinic, San Diego, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Kosty
authors.affiliation: American Society for Radiation Oncology, Fairfax, Virginia.
authors.forename: Anna
authors.initials: A
authors.lastname: Arnone
authors.affiliation: American Society of Clinical Oncology, Alexandria, Virginia.
authors.forename: Amy
authors.initials: A
authors.lastname: Hanley
authors.affiliation: American Society for Radiation Oncology, Fairfax, Virginia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stevens
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Christine
authors.initials: C
authors.lastname: Olsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018787:Radiation Oncology; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data; D014481:United States; D000078329:Workforce