Assessing the Coverage of US Cancer Center Primary Catchment Areas

Abstract

Background: Cancer centers are expected to engage communities and reduce the burden of cancer in their catchment areas. However, the extent to which cancer centers adequately reach the entire U.S. population is unknown. Methods:We surveyed all members of the Association of American Cancer Institutes (N=102 cancer centers) to document and map each cancer center's primary catchment area.Catchment area descriptions were aggregated to the county level. Catchment area coverage scores were calculated for each county and choropleths generated representing coverage across the U.S. Similar analyses were utilized to overlay U.S. population density, cancer incidence, and cancer mortality compared to each county's cancer center catchment area coverage.Results: Roughly 85% of U.S. counties were included in at least one cancer center's primary catchment area. However, 15% of U.S. counties, or roughly 25 million Americans, do not reside in a catchment area. When catchment area coverage was integrated with population density, cancer incidence, and cancer mortality metrics, geographical trends in both over-and-under coverage were apparent. Conclusion:Geographic gaps in cancer center catchment area coverage exist and may be propagating cancer disparities. Efforts to ensure coverage to all Americans should be a priority of cancer center leadership.Impact: This is the first known geographic analysis and interpretation of the primary catchment areas of all U.S.-based cancer centers and identifies key geographic gaps important to target for disparities reduction.

Delineation of Cancer Service Areas Anchored by Major Cancer Centers in the United States

“…Recent studies both complement this work and highlight its importance. One study examined geographic and population coverage of 102 AACI cancer centers and found that 15% of U.S. counties (∼25 million people) do not fall within an AACI cancer center's CA ( 36 ). This corresponds closely with our finding that 16% of the population lives in a CA that is not anchored by an AACI cancer center.…”

Addressing Public Health Aspects of Cancer Center Catchment Areas

“…The prevalence of women aged 40 years+ who received a mammogram in the past two years is high throughout the Eastern US and in pockets of the Northern US, but has lower values throughout the Southern US. We note that these areas where the prevalence of cancer risk-factors is high also have the highest cancer incidence and mortality rates in the United States (1). This suggests that next steps in the battle against cancer should be to reinforce programs geared towards cancer risk factors and early detection; this intervention will act swiftly on cancer incidence and mortality in the long run.…”

“…The article notes that many Americans reside outside of a cancer center primary catchment area, especially areas of the Southern US and Appalachia. Many states without a cancer center / comprehensive cancer center (Maine, Nevada, Wyoming, Montana, North Dakota, South Dakota, Alaska, Idaho) are part of the lowest population-density states (1). Within these states we can observe counties variability in cancer burden: in some, all-cancer incidence and mortality are among the lowest in the nation, while in others, values are among the highest.…”

Improved survival in cervical cancer patients receiving care at National Cancer Institute–designated cancer centers

“…This is particularly of interest given that access to NCICCs is limited; only 64 cancer centers are currently designated as NCI cancer centers across the United States (excluding basic laboratory cancer centers), with 14 states having none 22 . Despite NCICC catchment areas extending to more than 77% of US counties, 23 a recent report characterized 72% of US counties as undercovered by members of the Association of American of Cancer Institutes (the vast majority of whose members are NCICCs) 24 . Although there were 1.76 million new cases of cancer reported in the United States in 2019, 25 newly registered patients at NCICCs accounted for only 22% (387,415) of these individuals 26…”

“…22 Despite NCICC catchment areas extending to more than 77% of US counties, 23 a recent report characterized 72% of US counties as undercovered by members of the Association of American of Cancer Institutes (the vast majority of whose members are NCICCs). 24 Although there were 1.76 million new cases of cancer reported in the United States in 2019, 25 newly registered patients at NCICCs accounted for only 22% (387,415) of these individuals. 26 Given the declining use of cervical cancer BT and its effect on cervical cancer treatment and outcomes, we sought to evaluate whether receiving care at an NCICC was associated with improved cancer-specific survival among cervical cancer patients in California receiving definitive radiation therapy and whether guideline-concordant treatment, specifically concurrent chemotherapy and radiation with a BT boost, explained that association.…”